Tuesday, August 17, 2010

10 Tips for Caregivers

 Presented to me by the Home Health agency yesterday. I considered including only the issues affecting us at this time, then reconsidered. Readership is growing and perhaps due to so many who are dealing with some type of dementia in the home or family. There are many levels of deterioration, so to not include all of the tips seemed extremely selfish. Most of this we knew or have discovered, but still good tips overall.

TIP ONE:  Approaching The Patient

Approach the patient slowly and calmly.
Use Friendly tone of voice and facial expressions.
Make eye contact with the patient.
Face the patient when you speak to him/her.
Do not touch the patient from behind.
Speak slowly, clearly and distinctly.

Demented persons do not understand complex speech. Speaking slowly and facing the patient will increase the chance that the patient will hear sand understand you. Remember, even though patients may not understand, written or verbal communication, they do respond to the emotions of your voice and face. Do not ask the demented patient, "Do you remember me." Tell the patient your name first!

(The girls and I went through a safety session immediately following WB's first "run-away".  We continue to constantly modify our tone and expressions ~ this is part of our lives today)

TIP TWO:  Instructing The Patient

Use One-Step commands.
Use gestures to supplement words.
Patients with dementia cannot comprehend complex instructions. Example: Don't say, "Its time to eat, Mrs. Jones. Lets get up and go to the dining room. Where is your walker?" This conversation is too lengthy. The demented patient cannot understand all of this. It will be frustrating to him/her. You might say instead, "Mrs. Jones, stand up." After she stands, "Mrs. Jones, here is your walker" then, "Mrs. Hones, it's time to eat." Then begin leading her down the hall. These are one-step commands. This patient is told one thing at a time. 

(WB does not use a walker and can find his way around the house, but can never remember where the bowls, spoons, etc. are. We just say, "Are you hungry?" and he comes.

TIP THREE:  Dressing The Patient

Use One-Step commands.
Give the patent a limited choice of clothing to wear if the patient can still choose.
Limit the choices to two items. Too many choices confuse and frustrate the patient.
Use a consistent method of dressing the patient every day.
Use gestures and encouragement. Show the patient what to do.
For example:  Dress the patient's upper body first, and then go to the lower body. If the patient can still dress himself, hand him the articles of clothing in the same order - only one at a time.

(WB wears the same thing everyday. Makes it easy. If we're going somewhere that requires a different outfit, I will lay it out and generally have to help him get it all together and on his body. I believe he actually limits his choices himself to make it easier on all concerned)

TIP FOUR:  Bathing The Patient
Try and bathe the patient at the same time each day.
Use One-Step commands and go slowly.
Talk to the patient reassuringly during the bath. 
Explain what you are going to do in short, simple terms.
If the patient is afraid of the shower, try the tub. If the patient is afraid of the tub, try the shower.
Remember to provide privacy.

(We are not here yet. WB baths and showers himself, shaves and keeps his teeth and bridge sparkling. Nearly an obsession, he is quite tidy, neat and smells great all the time)

TIP FIVE:  Feeding The Patient

Make sure the patient is in an upright, comfortable position and ready to eat.
For patients who are poor eaters, observe the patient.
Consider the past eating habits when you can.
Give the patient preferred foods when possible.
Observe the patient to see if she has difficulty swallowing. Advanced patients forget how to swallow.
If the patient appears to think the food may be poisoned, medicine may help.

(WB has a yearning for sweets. If not watched, this is all he will eat. I believe now his brain is triggering that desire. He's always had a sweet tooth and has tested borderline diabetic. I refuse to take away the things he enjoys the most. I let him choose his breakfast, I prepare lunch and dinner and then a light desert. He will sneak around to get his sweets! Some days, lunch is light, dinner heavier. Other days he has a heavier lunch and a lighter dinner. It really depends on what's on hand  timing and our new "receiving guests" program. Sometimes dinner or lunch is delivered!)

TIP SIX:  Dealing With The Wandering Patient

Allow the wanderer as much freedom as possible.
A large line or strip of take or belcro on the door/floor may stop patients from goin past that point.
Remember! The patient may be looking for something or someone.
Take the wanderer to the toilet at least every two hours. 
No medication will stop the patient from wandering.
Try and redirect the wandering patient by giving them something to do.

A large stop sign on the exit door may help. Needing the bathroom is a major cause of wandering. 

(This is a real concern for us. WB isn't wandering, he does get turned around in the house but can generally correct rather quickly. He just sort of pivots until he decides. In the grocery store or department store, you cannot let him out of your sight. I am a fast walker and have to remind myself when he's pushing the buggy behind me to slow down. If I round the corner to the left for another isle I may find that he rounded it to the right)

TIP SEVEN:  Dealing With The Hostile Patient

REMEMBER!  There is a reason for every behavior. Try to determine the cause. Ask yourself the following questions"

Is this a new behavior?
Is the patient medically ill?
Does the patient have anything new in his environment such as a new caregiver, new housekeeper, new room or roommate, or change in routine?
Is the patient on a new medication?

(This is a major sticking point for us. Any changes in environment create additional anxiety for WB.  Also, I encourage all who call him on the phone to NOT tell him about an old friend's passing, NOT to talk about bankers, NOT to discuss the failing health of his mother. Light and airy is the mantra. Perhaps because he's always been short-tempered and had a low resistance to BS? Perhaps this is just normal for AD patients. Not sure, but when too many things are hitting the fan at one time, he's a flight risk. We've had one hostile encounter, it was scary. Remember, that's what landed him in the hospital last month)

TIP EIGHT:  Dealing With The Rummaging Patient

Direct the patient away from getting into others' things by re-directing. Give the patient something else to do such as offering dolls, stuffed animals to hold, magazines or books with pictures to look through, simple puzzles to put together, paper cups to stack, towels or laundry to fold, or put pennies in a jar.

(Yes, he does this. He will rummage through the mail and has no idea what any of it is, what it means, not a clue. Most of our mail is still addressed to him so that creates greater paranoia for him. Even though he cannot grasp what the content are, he still asks...over and over again. So, we scan the mailbox before he goes as it is part of his daily routine)

I will get this from them and edit this post as soon as possible.

TIP TEN:  Remember!

Demented patients have brains that are dying. Most of the time, they cannot help behaving the way they do!

Keywords: Early Onset Alzheimer's Dementia, Billy Ray Brantley, Caregiver
My name is Rhonda Brantley. My husband Billy Ray Brantley has Early Onset Alzheimer's Dementia.

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