Practical tips on dealing with the common challenges of Alzheimer's disease

The following suggestions are taken from the experiences of caregivers. You may find some difficult to carry out. Remember, nobody is perfect. You the caregiver can only do your best.

Bathing and personal hygiene

The person with AD may forget to bathe or no longer recognise the need, or may have forgotten what to do. In this situation it is important to respect the person’s dignity when offering to help.

Suggestions:

• Maintain the person’s former routine for washing as much as possible
• Try to make bathing a pleasant and relaxing occasion
• A shower may be easier than a bath but if the person has not been used to a shower it may seem alarming
• Simplify the task as much as possible
• If the person refuses to bathe, try again a little later, when the mood may have changed
• Allow the person to do as much as possible unaided
• If the person appears embarrassed, keeping portions of the body covered while bathing may be helpful
• Think about safety. Something firm to hold on to, such as grab rails, a non-slip mat or an extra chair, all help
• If bathing always leads to conflict, a stand-up wash might be better
• If you constantly have problems helping with this, get someone else to do it

Dressing

The person with AD will often forget how to dress and may not recognise the need to change clothes. Persons with AD sometimes appear in public with inappropriate clothing.

Suggestions:

• Lay out clothes in the order they are to be put on
• Avoid clothes with complicated fastenings
• Encourage independence in dressing as long as possible
• Use repetition if necessary
• Use non-skid rubber-soled shoes

Toileting and incontinence

The person with AD may lose the ability to recognise when to go to the toilet, where the toilet is or what to do when in the toilet.

Suggestions:

• Create a schedule for going to the toilet
• Label the toilet door using bright colours and large letters
• Leave the toilet door open so it is easy to find
• Make sure clothing can be easily removed
• Limit drinks within reason before bed time
• Providing a chamber pot or commode by the bedside may be helpful
• Get professional advice

Cooking

For the person with AD, the ability to cook may be lost in the later stages. This poses severe problems if the person lives alone, with an increased risk of injury. Poor physical coordination can lead to burns and cuts.

Suggestions:

• Assess how well the person can do their own cooking
• Enjoy cooking as a shared activity
• Install safety devices
• Remove sharp utensils
• Provide meals, or meal service, and try to see that enough nutritious food is eaten

Eating

Persons with dementia often forget if they have eaten, or how to use utensils. In the later stages of Alzheimer's disease the person may need to be fed. Some physical problems will arise such as not being able to chew properly or swallow.

Suggestions:

• You may have to remind the person how to eat
• Use finger food – it can be easier to manage and not as messy
• Cut up food in small pieces to prevent choking. In the late stages of the disease, it may be necessary to mash or liquidise all food
• Remind the person to eat slowly
• Be aware that the person may not be able to sense hot or cold, and may burn their mouth on hot foods or liquids
• When the person has difficulty swallowing, consult your physician to learn a technique to stimulate swallowing
• Serve one portion of food at a time

Driving

It could be dangerous for the person with Alzheimer's disease to drive, since judgment is impaired and reactions are slowed.

Suggestions:

• Discuss the subject with the person gently
• Suggest using public transportation, as appropriate
• If you cannot dissuade the person from driving, it may be necessary to consult with your doctor or the drivers licensing authority

Alcohol and cigarettes

There is no problem with the person with AD drinking alcohol in moderation, if medication problems are not involved. Cigarettes introduce a greater danger because of the risk of fire and damage to health.

Suggestions:

• Supervise the person when smoking; or discourage smoking altogether - perhaps with a physician’s prescription
• Check alcohol and medication with your doctor

Difficulty sleeping

The person with AD may be restless at night and disturb the family. This can be your most exhausting problem as a caregiver.

Suggestions:

• Try to discourage sleeping during the day
• Try daily long walks, and add more physical activity during the day
• Try to make the person as comfortable as possible at bed time

Repetitive behaviour

A person with Alzheimer's disease may forget what they have said from one moment to the next, leading to repetitive questioning and actions.

Suggestions:

• Try to distract the person with AD, offering something else to see, hear or do
• Write down the answer to commonly asked questions
• Give hugs and reassure with warmth, if appropriate for the person

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