Coping with Anger and Agitation in Alzheimer's

A study was done to test the quality of life of individuals living with Alzheimer's disease and their caregivers, prior to and after an occupational therapy intervention in mid-stage Alzheimer's. The study revealed that adherence to occupational therapy recommendations derived from individualized assessment produced significant improvements in quality of life for the person with Alzheimer's disease living in the community and significantly diminished the burden felt by family members caring for them.1 Common mid-stage Alzheimer's symptoms There are a variety of symptoms unique to mid-stage Alzheimer's disease, including:2 Problems with cognition: a person can be confused, not know where they are, unable to recall the day of the week or the year they are in. Become forgetful of names of their close family members, have difficulty or an inability to understand and express themselves through speech, and often display difficulties finding the right words when they speak. However, they are still able to respond to instructions. Behavior: increased anxiety, disruptive with physical and/or verbal aggression. Inappropriate behavior in social situations. Wandering with higher prevalence in the later afternoon or night-time. Increased suspiciousness and paranoia of others, along with frequent social withdrawal from others, hallucinations, and resistance to care. Problems with daily living skills: decreased motor skills and ability to interpret sensations. Difficulty recognizing items, and poor safety awareness are notable at this stage. These deficits lead to the person requiring assistance for tasks such as grooming and hygiene, feeding, and dressing tasks. Additionally, at this stage, an individual's ability to perform, instrumental activities of living (IADL's), such as shopping, driving, doing laundry, medication management, and using the telephone are often greatly affected and require much assistance.2 Occupational therapy in mid-stage Alzheimer's Evaluation Occupational therapists will perform very specific evaluations on the person to assess their ability to carry out their daily living tasks and navigate in their home environment. The caregiver's input and level of assistance they provide are also an important part of the evaluation process.2 OT for middle-stage Alzheimer's Occupational therapists can help explore and brainstorm ideas to help keep the person cognitively engaged and stimulated with activities, that they might enjoy doing. An OT can also help caregivers and loved ones with strategies to continue to include the person in family activities, parties, and social outings.2,3 Additionally, the evaluation of the individual's performance of everyday tasks in their home environment (home-based performance evaluation) is of extreme importance.2,3 Home modifications Education of home modifications for caregivers to address potential environmental hazards and prevent injury. Some examples might include: disabling the garbage disposal, removing throw rugs, keeping cleaning supplies and medications out of reach and in locked cabinets, using electrical covers over sockets to prevent injury, use of childproof knobs on the stove, or replacing a glass shower door.2,3 Caregiver education and adapting communication OTs can educate caregivers and help to provide potential strategies to help their loved ones function in their environment, with the presence of their cognitive impairments.2,3 Focus on the caregiver's ability to recognize any triggers that cause or increase stress and agitation in the person. For instance, mirrors can potentially cause increased anxiety. Sometimes when individuals battling Alzheimer's disease see their reflection, they don't recognize themselves. This can increase their anxiety level and feelings of being watched or followed by someone they don't know. Removing or covering mirrors is a simple strategy that could help.2,3 Educating and assisting caregivers to break down tasks and simplify them for the person. Breaking tasks down into segments helps. It makes the activity easier to for the person to think through.2,3 Education of caregivers in the use of cues during activities. When used appropriately, verbal, visual, and touch (tactile) cues or hand over hand assistance, as needed, is extremely helpful with an individual in mid-level Alzheimer’s disease. It helps the person to still engage and participate in purposeful activities.2,3 Home occupational therapy programs Instruct patient and caregivers in a home OT program with visual and verbal cues as needed. It is very important to incorporate strength, endurance, and range of motion activities into the person's daily life.2,3 Having a structured schedule of self-care tasks, leisure activities, rest periods, and sleep are very important. Occupational therapists will work with the patient and caretaker to create a schedule and provide it in written or visual form for the person. Keeping the schedule visually simplistic will help to not overwhelm the person.2,3 OT as part of the treatment team Occupational therapists can help in so many different ways, in each stage of Alzheimer's disease. This therapeutic intervention can be a benefit for not only the person but for their family and caregivers as well. If your feel OT could be of benefit to your loved one and your family. Then reach out and have a conversation with your doctor. If your doctor feels that OT could be of benefit, they can refer you and your loved one to occupational therapy. Most insurances will cover OT services. Contact your individual insurance company regarding your specific plan's coverage. Have you utilized occupational therapy for middle-stage Alzheimer's? Want to talk to other's in the community about occupational therapy? Tell us about your experience in the comments below, or share your story with the community. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"],Much has been written, sung, photographed, filmed, orated about the beautiful word "love." People love pizza, television shows, sports teams, vacation destinations. People love each other. Often that love is expressed in words, poems, songs, looks, touch. Most often in my experience it is described as a strong emotion based on appeal or some sort of reciprocal care and affection. It seems that romantic love is part of nearly every film in some way. People fall in and out of it. I watch Hallmark romance episodes with my loved one and in less than 90 minutes character go from loving one person to another. Is this true love? I guess it can lead to it. Every hour of every day I'm not writing about that kind of love. I am writing about the type of love that I see exhibited every hour of every day by caregivers of Alzheimer's patients. This kind of love is rarely shown television or film. This love changes pull-ups. It bathes and dries off. It brushes teeth. It cares for the sick. This kind of love is okay with not being thanked or reciprocation. This love inspires I want to you all to know that I see you. I see the way that you care, and love and I am impressed every day. You are truly loving. You are appreciated in the darkest of nights and longest of days. Your kind of love asks nothing but gives everything. I applaud you. Your special kind of love motivates me to love well. I am not naturally a giving person. My own traumatic life experience taught me to care for myself first, but your example is teaching me to love others as I love myself. Your love inspires me to be more loving and that is the beauty of this community. We are a community that truly loves. In every home I was watching an old episode of The Love Boat recently and thought about the opening song's lyrics, "Love, exciting and new," and "love won't hurt anymore." It was a fun show for us babyboomers and those who watch classic television. For years, I thought love was found on a moonlit deck over some fake ocean backdrop. Now, I know that true love is found in every home where Alzheimer's patients experience care. Take heart, caregiver So, what is the point? Take heart in knowing that you are the most loving people ever. Take heart in knowing that people notice and admire the way that you love. Take heart in knowing that when things are tough that your unconditional love is the very definition of love. Take heart in knowing that every act of love that you share in our community inspires others by your example. I want to encourage you today that we are all in this together, this community of love. You are not alone. We all know and feel your loving commitment. The term "loved one" is not merely a description of the person we care for, but the very definition of how we do it. [poll nexus_id=18220] What inspires to love selflessly? I've cared for my mom who lives with dementia full-time for about 4 years, and I learn something new every day. I’ve learned that I can let go of certain things that I or my mom used to put a lot of importance on. Over time it has gotten easier to let go of making everyone happy about my mom’s care, making epic memories with my mom, and expecting my mom to be who she used to be. [forumDriver id=14481] We don't have to make everyone happy I used to worry all the time about how other people were responding to my mom’s dementia behaviors or my own decisions as a caregiver. I lost sleep over who was mad at me and I spent a lot of time on email and phone calls trying to explain my caregiving decisions to my mom’s family and friends. I wanted everyone’s approval before I could be at peace. I am learning to let these things go. Not everyone is going to understand our decisions as caregivers and some might even be mad at you about them. Of course this still bothers me, but I reassure myself that my mom is safe and well-taken care of. I’m picking my battles and deciding to put my energies toward her care and the care of my own family instead. We don't have to make epic memories with our loved ones It can feel urgent and important to make those big memories with our loved ones while they are still with us. Early in my mom’s Alzheimer’s journey, she really wanted to take my family to Disneyland. It was not an easy trip for her - the crowds were overwhelming, she got stressed when she didn’t know what we were doing next, and we had to plan snack and bathroom breaks for her as well as my kids. But we planned as well as we could and she was able to enjoy it and the time with my kids. Now my mom is past the point of being able to do any big trips or over-the-top celebrations. We try to slow down, weigh her progress, and think about what she can realistically enjoy. Then we adjust our plans accordingly. And we continue to cherish those big trip memories we made before Alzheimer’s took over. We don't have to expect our loved one to be who they used to be Before my mom had dementia, she was a high-octane civil servant, always volunteering at charity events or fulfilling her role as board member of the many local organizations she was an active part of. She exercised every day and was fastidious about her diet. Now, because of dementia, she prefers to wear some of the same clothes over and over again. She often forgets appointments and important dates, and never passes up a chance to enjoy dessert or a sweet treat. I wrestle with this a lot. Who is this person? She doesn’t seem much like the mom I used to know. I want to honor who my mom used to be while also respecting who she is now. Instead of forcing her to be the person she was before dementia, I’m focused on my mom having safety, routine, stimulation, and independence. I want her to feel productive and useful in her everyday life. I encourage her to be comfortable in whatever clothes she wants to wear and enjoy foods she wants to eat. She is safe and happy. This is a battle worth fighting - letting her be the person she is now, even though it’s different than who she was. Pick your battles and lighten your load Caregivers have a monumental job taking care of someone living with dementia. There are so many things to focus on but it’s not humanly possible to cover them all. Let’s not make our job harder! Alzheimer’s caregivers need to pick their battles. When caregivers focus on the most important things and let go of the rest, we take immense pressure off ourselves and our loved ones. ,About five years into my mom's Alzheimer's journey, I was spending the night at my parents' house and decided to help my mom get ready for bed, so my dad could have a break. I had never helped her get ready for bed before, so I wasn't familiar with her nightly routine. At the time, my mom's Alzheimer's was moderate, but she knew enough to know that it felt weird for her daughter to be helping her get ready for bed. Getting my mom ready for bed Despite some resistance from my mom, I helped her change into her pajamas and led her into the bathroom. I told her to brush her teeth. My mom looked at me, clearly confused by what I was asking her to do. I asked her if she needed help brushing her teeth and she told me that she had already brushed her teeth that day. I argued that although she had brushed her teeth once in the morning, she needed to brush them again before bed. She insisted that she only brushed her teeth once a day and I insisted that she needed to brush them again at night. We went back and forth like this for several minutes before she became really agitated with me. I finally decided to let it go and I helped her get into her bed. Confusion about the argument The next day, my dad told me that my mom had woken up in the middle of the night, thinking she and my dad had gotten into an argument. He said she was really upset about it and kept him awake for a while. She brought it up again when they woke up in the morning. He had no idea what she was referring to and just assumed it was something she had imagined. I knew exactly what she had been referring to. I told my dad about our argument the night before when I kept insisting that my mom brush her teeth again before bed. I told him she must have gotten confused about who the argument was with, but clearly, she remembered having an argument with someone and it really upset her. I felt terrible! [poll nexus_id=10620] Arguing with a loved one who has Alzheimer's Did it really matter if my mom with mid-stage Alzheimer’s brushed her teeth twice a day? No. Did insisting on it and arguing with her about it help the situation in any way? No. The minute my mom became agitated at the idea of having to brush her teeth a second time I should have let it go. I had never helped her get ready for bed before, and I wasn't familiar with her nighttime routine, so I didn't know any better. But I should have known better not to argue with her about it. I should have just let it go and asked my dad about it later. My mom was clearly upset by this idea and arguing with her only made her more upset, so much so that she kept my dad up in the middle of the night because of it. Managing arguments with Alzheimer's Although I regretted this interaction with my mom, I was grateful it happened because I learned the importance of never arguing with someone who has Alzheimer's. I learned that you have to pick your battles carefully and most of the time, it is simply not worth the agitation it will cause your loved one. I learned to just let it go. Sometimes you have to ask yourself, "Do I want to be right or do I want to be happy?" Are you currently navigating symptoms like agitation in yourself or a loved one? Talk about it with others who understand, and join the conversation. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"]

Coping with Anger and Agitation in Alzheimer's

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