How quickly symptoms are seen and how fast the stages progress will vary depending on age of onset and the person. Typically, the average patient lives from eight to 10 years after they are diagnosed. However, the patient can live for more than 20 years (Hegner & Acello, 2014). The younger the onset of the disease the more aggressive the disease will be.
The patient should be encouraged to maintain their independence in as many ways as possible for as long as possible. However, as the disease progresses, it is important to keep several things in mind. Overstimulation, for example, may cause acting out behaviors or wandering behaviors in the Alzheimer patient. The care giver may also need to explain direction several times, slowly and as simply as possible. Communication will be impaired. Understand that the patient may not communicate well or not at all. They may lose their train of thought or forget words. If changes are noted, report those to the nurse.
It is important to support the patient and help them maintain their self-esteem. Helping the patient to reminisce about happy times in their life is one way to accomplish self-esteem (Halter, 2014). Accept the patient without being judgmental or critical. For example, remember that confabulation is not lying. Confabulation is unconscious (Halter, 2014). Never argue with the patient. Instead try distraction using realities around the patient such as a photograph in the room (Hegner & Acello, 2014). The best way to work with a patient diagnosed with Alzheimer’s disease to provide a quiet, calm environment that is structured and consistent. It is also helpful to maintain eye contact when appropriate, watch body language, try to understand nonverbal cues of the patient, and use touch appropriately (Acello & Hegner, 2015). Use simple short phrases and words when giving directions. Speak slowly and clearly while standing close to the patient. This will help them to focus on you and what you are saying (Halter, 2014).
Monitor the patient’s eating habits. Be sure to offer fluids that the patient likes. The family may be of valuable help and offer suggestions. Also, offer the patient finger foods one at a time can avoid confusion or over stimulation (Acello & Hegner, 2015). Too much food in front of the patient may cause them to become anxious and not eat. Check food for the temperature as well. Reheating food that the patient is eating slowly may also help with acceptance. Help the patient prepare food such as buttering bread or removing wrappers. Puree foods may be required if the patient is not able to chew well (Acello & Hegner, 2015). The patient may also need help feeding themselves or be completely dependent upon someone feeding them. Take the time to help the patient eat slowly and encourage food intake. Remember that they may be slow to eat food. If there are any changes in behavior, the patient refuses food or fluid or is unresponsive notify the nurse. The patient may also need to have their mouth checked for food in their cheeks. This can cause choking and cause the patient to stop eating (Acello & Hegner, 2015).
The Alzheimer patient will also have good days and bad days. There may be problems with various aspects of their daily routine such as bathing or dressing as well as wandering or behavioral problems. The patient may have forgotten how to bathe or eat or may not understand the purpose any longer. It is important to be patient and not agitate the patient. If the patient refuses to eat, dress, or bathe, keep trying throughout the day. Try to change the environment or your approach toward the patient (Acello & Hegner, 2015). Consult the nurse if the patient does become agitated or if the refusal continues. If the patient is able to perform activities of self-care, be sure to allow plenty of time and give simple short tasks and only a few choices. Directions should be given one step at a time so they are not overwhelmed. Watch the patient carefully for nonverbal cues as well as verbal cues.
Wandering or Sundowning is another issue that is particular to dementia patients. No one knows why this occurs. The patient will try to leave the facility or wander around the unit. This usually happens toward the evening hours but can occur anytime during the day. Remember that a patient with Alzheimer’s often gets their night and day hours mixed up. They may think it is time to go to work when it is actually dinner time. The person is seeking a state of mind, not a place (Acello & Hegner, 2015). Avoid arguing or telling the patient they are in a facility and cannot leave. Instead use distraction by getting the patient to tell you what kind of hobbies they like or what they used to do for a living. Walking with the patient can also be a strategy to gently guide them back to where they should be (Hegner & Acell0, 2010). Sundowning can have many triggers. Try to keep a log to see if there is a pattern to the behavior (Acello & Hegner, 2015). Are there unmet needs or feelings that the patient is seeking? The wandering patient can also become exhausted. Watch the patient for an unsteady gait or leaning on the wall. Be sure there are chairs nearby for the patient to sit. Encourage the patient to sit frequently and offer fluid or finger foods.
Try to understand if the patient is uncomfortable or has unmet needs such as toileting, hunger, or clothes that are pinching. Unmet needs can also cause anxiety or agitation (Acello & Hegner, 2015). This behavior can occur due to a sudden change in routine, place or even people. Too much stimulation may be another reason for agitation. Distraction is one way to help the patient overcome this behavior. It is easier to deal with agitation or aggression before it gets out of hand. If you see sign of a patient becoming agitated, try to find the cause and remove it. The patient may also exhibit pacing or preservation behaviors. If the patient becomes agitated, do not use force or demand the patient behave. Only a few of the staff should approach the patient. It can be dangerous to approach alone but too many staff can create additional agitation. Be aware of your own body language as well as the patient. If the patient is clenching fists or threatening, stand more than an arms length away. Use a soft, low, calm voice to speak to the patient. Be careful with touch, some patient may react violently if they are already agitated (Acello & Hegner, 2015). Notify the nurse if the patient continues to become agitated or violent.
Any changes in the patient’s behavior should be reported. This includes bathing or eating habits, grooming, activity, behavior, dressing, or thought process. Furthermore, anything out of the ordinary such as profuse sweating, diarrhea, excessive drowsiness, falls, bruises, vomiting, muscle spasms, confusion, trouble breathing, or constipation should also be reported. Listed below are other observations that should be reported (Acello & Hegner, 2015):
- Changes in alertness or awareness of current surroundings
- Changes in mood or emotions
- Changes in awareness of person, place or time
- Changes in communication such as verbal or non verbal responses
- Memory changes such as more forgetful or a sudden inability to recall items or people
- Unusual or new behavior not seen before
- Increase anxiety or agitation
- Tired for no reason, falling asleep at odd times
- Wandering more
- Unusual pattern of bowels
- Increases in confusion
- Changes in vital signs
- Signs of other illness