Physical Needs And Safety

Caring for persons with Alzheimer's disease or similar dementia is difficult because the affected individuals gradually forget how to care for themselves.

When self care tasks are organized into smaller, simpler steps that match the person's abilities, the person is more likely to succeed.

Following is a list of physical needs along with helpful suggestions that caregivers can use.

Nutrition

During the middle and late stages of Alzheimer's disease, eating becomes difficult. The individual may not remember when they ate, recognize feelings of hunger, be able to determine if food is too hot or too cold, or even remember to chew or swallow.

Self-feeding may be made easier by using adaptive, easy grip utensils available from medical equipment stores, your local pharmacy, or from health product catalogs.

Simplify mealtime by limiting the number of food choices. Serve one food at a time and use one utensil at a time. Keep portions small and serve foods that were favorites before the onset of the disease. Prepare finger foods if the person is unable to use utensils. Give simple directions. For example say, "Pick up your spoon, put some food on it, raise it to your mouth."

If the person resists eating, check the environment. Is the room too noisy? Turn the TV and radio off during meal times to limit distractions. Check also to see if the problem could be poor fitting dentures, cavities or other mouth infections that could be a source of pain. Dry mouth can also make eating difficult. A physical illness, such as diabetes, intestinal disorder, infection or constipation can also lead to loss of appetite.

Select foods that are more easily chewed and swallowed. Moisten foods with gravy or sauce. Avoid foods with tough skins, seeds or bones and foods that are dry or sticky. The individual may have difficulty chewing and swallowing. Stroking the throat and gently guiding the chin may remind them to chew and swallow.

The person with Alzheimer's disease often forgets to drink fluids or even ask for a drink. Failure to drink enough fluids will cause constipation and may result in dehydration. It is important for the caregiver to offer plenty of fluids.

People with dementia may lose weight due to physical changes and/or excessive wandering and anxiety. They may require more calories than normal aging adults. At times they may eat excessive amounts of foods and gain too much weight or stop eating and experience unusual weight loss. The caregiver will need to adapt meal plans to these changing conditions. A registered dietician recommended by your physician can be consulted to help you develop a diet plan that meets the individual's nutritional needs.

If the person loses all interest in food or pushes food out of the mouth by tongue movements, they may still be willing to drink nutritional supplements. The use of feeding tubes with prepared nutritional liquids might also be an option to be discussed with your physician.

Dressing

Choosing clothes and dressing can be frustrating for the person with Alzheimer's disease. They may not remember how to dress or be overwhelmed with the number of choices.

Offer two choices of clothing. Lay out the clothes the person is to wear in the order that they are to be put on or hand the person one item at a time. Give short and simple instructions such as "put on your shirt" rather then "get dressed." The person may want to wear several layers of clothing.

If clothing is difficult to put on, you may want to adapt regular clothing. Replace buttons, snaps, and zippers with velcro. Adaptive clothing can be purchased at clothing stores and through catalogs. Sweat suits and other simple slip on clothing may work well. If the individual chooses the same outfit, purchase several of them.
As the disease progresses, the caregiver will need to provide more assistance during dressing.

Bathing

Bathing involves many steps and the person with Alzheimer's disease may perceive it as unpleasant or threatening. They may refuse to get into the water because the running water may frighten them or they don't remember why they need to bathe. They may be too modest to remove their clothing and want to avoid the discomfort of being cold.

Gather supplies such as towels, washcloths, soap and shampoo in advance, so you and the person can focus on the bathing task. The bathroom should not be cluttered. Too many items sitting out may be distracting for the individual.

Choose a time for bathing when the person is calm and relaxed. Let the person feel the water before sitting in the bathtub or entering the shower.

Bath time provides a good opportunity for you to check for rashes, bruises, dry skin or other physical problems.

Sponge baths may be sufficient to maintain good hygiene and skin care. It is important to encourage participation and create a calm, private and supportive atmosphere.

Toileting

It is common for a person with Alzheimer's disease to experience loss of bladder and/or bowel control. Individuals may be embarrassed and upset when they have "accidents."

Caregivers can help by assisting or directing the individual to the bathroom about every two or three hours. Watch for restlessness or signs of discomfort and remind the person to go to the bathroom. Record bowel movements on a calendar to be aware of problems with constipation. To reduce constipation provide well-balanced meals with sufficient fiber and offer the person 6-8 glasses of liquids each day.

The caregiver can choose from a variety of adult diapers or washable briefs. Check with your local Alzheimer's Association office. Some offer adult diapers at a reduced price. A reassuring attitude during care will help lessen feelings of embarrassment.

Preparing for Emergencies

Place emergency phone numbers and numbers of key persons by all phones. Provide home keys to family and neighbors in case of an emergency.

Alzheimer's disease causes the individual to lose their ability to recognize familiar places and faces. They may become lost in their neighborhood. Although common, this behavior can be dangerous to individuals and stressful for caregivers. Alert your neighbors or the staff in the retirement community where the person resides about their condition. Ask them to contact you if they see the person outside without supervision.

Record detailed information which will identify the person should they get lost. Include age, height, weight, hair color, eye color, identifying marks, blood type, medical condition, medication, dental work, jewelry, allergies, and complexion. Keep a current photo of the person available. Enroll the impaired individual in the Safe Return Program.

General Safety Tips

Keep walking areas clear.
Provide sturdy items to lean against along a main path.
Use furniture to block dangerous areas.
Tape down electrical cords.
Remove or secure in a safe area, guns, power tools, electrical and motor operated equipment.
Reduce glare.
Remove throw rugs.
Supervise smoking, keep lighters, matches and cigarettes in your possession.
Supervise consumption of prescription and over the counter drugs.
Lock up all medications.
Secure outside doors with key operated dead bolts.

Safety with Steps

Mark changes in floor levels with reflective tape.
Illuminate staircases, equip with handrails on both sides.
Make sure carpeting is tacked down on all sides

Bathroom Safety

Install grab bars in the bathroom and tub area.
Put non-skid floor adhesives in tub or shower.
Install a raised toilet seat, use a shower bench.
Use night lights on the path to the bathroom.
Put toiletry items in a locked drawer.
Remove electrical appliances from the bathroom to reduce the risk of electrical shock.

Kitchen Safety

Remove "on-off" knobs from the stove when not in use.
Hide all knives and sharp utensils or lock them up.
Lock up cleaning chemicals or put in a safe place.
Install smoke detectors.
Install childproof locks and doorknobs.

Driving and Dementia

Giving up driving is very difficult for most people with dementia. Driving gives a person freedom and control, a sense of self-esteem and independence.

Some individuals in the early stages can drive to familiar places. Others are vulnerable to situations requiring quick decisions and a degree of concentration they no longer have. Eventually, despite resistance, family members must limit and eventually eliminate the persons driving opportunities.

Caregivers should watch for the following signs, and if indicated take steps to insure the person stops driving;

Forget how to get to familiar places.
Fail to follow traffic signs.
Use poor judgment of distance, make turns that are too wide or too tight, etc.
Make poor decisions in traffic, fail to yield the right of way, react slowly to emergencies.
Travel at the wrong speed.
Become confused or angry while driving.

A family member, caregiver or friend concerned about the wisdom of a loved one continuing to drive may seek the assistance of the state by sending a signed letter of concern to:

Director
Division of Motor Vehicles
Docking State Office Building
915 SW Harrison Avenue
Topeka, Kansas 66626-0001
Telephone: 785-296-3601

Physicians, attorneys, case managers, social workers, legislators and law enforcement officers may also initiate the contact.

The letter should contain the name of the person, the license registration number, and some examples of the person's unsafe driving because of medical reasons (can include Alzheimer's disease or another form of dementia) and why you feel it is unsafe for the person to continue operating a car. You should request that the person's driver's license be revoked.

The DMV, upon receiving your letter, will send the person a letter containing medical forms that need to be filled out by the person's doctor. If these forms are not returned within 30 days, the driver's license will be revoked for failure to submit an acceptable medical report.

If the forms are filled out and returned to the DMV within 30 days, they will be reviewed and the doctor's recommendations will be taken into account in deciding what the next steps will be. Generally, there are three options: (1) revoke the license if the doctor states that the individual should not be driving, (2) authorize a full test if the doctor states the person is medically and physically capable of driving, and (3) submit the medical information to the Medical Advisory Board for their opinion.

If the person cannot pass the testing, the license will be revoked. If the person passes the testing (and this may well happen in some cases of dementia), the driver's license will be restricted as recommended by the doctor and the examiner. An annual medical reporting requirement may be added to the license for follow-up.

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