Caregiver Insights
Dealing with Challenges
Safety Comes First
One night, my wife woke me up at 2:15. She was disoriented, cold, and quivering. She had been wandering around the house and was concerned that nobody was around. I hugged her until she relaxed, and she told me she had taken her pills for tomorrow. We went back to sleep, but when I got up in the morning, I discovered that she had taken all of her pills for the week. Our doctor told me to take her to the ER because he was unsure of how she would react to having taken so many doses of blood pressure medicine at one time. Fortunately, it all worked out okay, but it was a warning that I had to be more aware of the unexpected.
As dementia progresses, safety risks increase, and with everything else going on, it is easy to overlook the need to prepare for dangers even within our own homes. Caregivers often seek out advice provided by the Alzheimer’s Association, National Institute on Aging, dementia care professionals, or occupational therapists to help evaluate their loved one’s needs. This article is limited to reviewing the major concerns we should be aware of so we can decide how to proceed. Our main safety concerns are dangerous substances, fall prevention, wandering risk, eating and kitchen activities, and bedroom and bathroom safety.
Dangerous Substances
People with dementia are declining both physically and mentally. Injuries and sickness are to be expected, but there is no way to be sure of what is coming next. What we do know is that at some point we must control access to alcohol, cleaning products, sharp objects, and other potentially harmful items. Medications should be a high priority. The time to take control and be responsible for administrating meds is before a crisis occurs. We can never be clairvoyant, but It is prudent to at least try to be prepared for unexpected events.
Fall Prevention
We are all aware that people with dementia have a higher risk of falling down, and that this can cause serious consequences. What is less known is that balance issues are often compounded by low blood pressure, muscle weakness, poor depth perception, medications, and environmental problems – like loose rugs, poor lighting, and clutter. This is important because it means that we can help reduce falls by encouraging exercise, improving lighting, monitoring medications, eliminating loose rugs, reducing clutter, and installing handrails where appropriate. Together with holding hands or locking arms to provide support when walking together, we can make a significant difference.
Wandering Concerns
Wandering is a serious issue for dementia caregivers, particularly for those dealing with Alzheimer’s disease. Loved ones can slip away at any time of the day or night and forget where they are going or how to get back. In their confusion, they can drift into traffic or other threatening situations. This is one of the most unnerving fears caregivers face, resulting in anxiety for both the caregivers and their loved ones.
Fortunately, there are multiple actions that can reduce the risks, including (1) installing high or low door locks outside the normal line of sight, (2) adding door chimes or alarms, (3) providing GPS-enabled watches or locator devices, (4) using smartphone tracking apps, (5) providing medical ID bracelets, and (6) registering with local police departments or wander-response programs. The Alzheimer’s Association, in collaboration with MedicAlert® Foundation, provides a nationwide emergency response service.
Eating and Kitchen Activities
Caregivers have mixed reactions about dietary issues, but weight loss and dehydration are usually the greatest medical concerns, because they can lead to increased illness, functional decline, hospitalization, and even death. Offering meals and fluids at the same times every day is helpful, but providing smaller snacks and fluids at other times of the day is also appropriate. If unwanted weight loss occurs, increase calories and protein. When eating or fluid intake remains too low, a registered dietitian or occupational therapist can often provide individualized advice.
Kitchens are high risk areas for people with dementia because they expose people to heat, sharp objects, electricity, gas, water, medications, and potentially toxic substances. For healthy adults, these pose no problems, but dangers increase with dementia. To avoid problems, caregivers need to stay aware of their loved one’s changing limitations. (This became vividly apparent one night when gas fumes alerted me that my wife had wandered into the kitchen and turned on the stove.) Two other thoughts: preparing meals in advance reduces risks, and it is prudent to remove spoiling foods from the refrigerator.
Bedroom and Bathroom Activities
We are all familiar with waking up groggy on occasion. Imagine being really groggy every time you wake up. People with dementia have irregular sleep patterns and often wander in the middle of the night. Total darkness, dark rugs that may appear to be holes, clutter, and loose rugs invite accidents. Consider nightlights and keep the floor free of obstacles.
Hygiene declines as dementia progresses. Along with other behavioral changes, this becomes one of the greatest challenges for caregivers. From brushing teeth to eventual incontinence, intervention becomes necessary and progressively more difficult. Poor hygiene can cause UTIs, which frequently increase the progression of dementia. A few simple tips: (1) limit wardrobe choices to easily removable clothing, (2) maintain a consistent routine, (3) keep personal care products (including disposables) visible, (4) offer choices like “would you like to shower now or after breakfast,” (5) add non-slip bath mats, (6) ensure that the room and water are comfortably warm, (7) respect privacy by covering the person with towel when possible, and (8) if there is daily cleaning of hands, face, underarms, and groin, full showers or baths may only be necessary once or twice a week.
Conclusions
This article deals briefly with some of the difficult aspects of dementia caregiving. But while none of us ever expected to be in this role, we love and we care. So, we keep on giving – as millions of people before us have done. And we continue to prepare for whatever will come next. We should take pride in the way we are handling the huge challenges that have come our way. We are making a huge difference for people who have also made a difference in our lives.
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