Dementia is a general term that refers to a serious loss of mental abilities such as thinking, remembering, reasoning and communicating (Alvare, Fuzy, & Rymer, 2009). Alzheimer's is a progressive form of dementia that cannot be reversed. It eventually affects brain functions, erasing memory, communication skills, movement and behaviors. Alzheimer's residents lose their ability to chew and swallow food. As residents journey through the stages of Alzheimer's disease, they become completely dependent on their caregivers. CNAs have to be able to be patient and compassionate while giving care to this special population, and remember that they cannot respond like a normal adult. As the disease gets worse, the response of the dementia patient becomes more like an infant. They do not understand what you are saying and cannot communicate what they mean to you. The dementia patient is confused and easily frightened. As dementia gets worse, the resident does not respond with normal social behavior.
It is very important to know the different stages of Alzheimer's disease to be better able to care for the residents. Not all residents have the same signs at the same stage in the disease. One resident may be able to play a musical instrument, but not be able to carry on a conversation. Another may be able to read, but not be able to feed him/herself. The following chart shows how the resident changes in each stage of Alzheimer's disease (Alvare, Fuzy, & Rymer, 2009).
Stages of Alzheimer's Disease
|Stage 1 Symptoms||Stage 2 Symptoms||Stage 3 Symptoms|
|Short term memory loss||May forget family/friends||Total disorientation|
|Inability to concentrate||Difficulty finding right words/following directions||Apathy/total dependence|
|Irritability/rude behavior||Restlessness/wandering||Confined to bed/chair|
|Carelessness in personal habits||Incontinence at times||Total incontinence|
|Poor judgment||Lack of impulse control||Inability to speak, except for grunting, screaming|
|Sleeps, but gets night/days confused||Sleep problems||Increased sleep problems|
|Feeds self||May need cueing to feed self||Difficulty swallowing, high risk for choking|
The NA needs to pay attention to each stage so communication can continue. In stage 1, the resident may be irritable or make rude comments. You must not take anything the resident says personally. If your feelings get hurt, the resident will notice, and continue the rude behavior. In stage 2, lack of impulse control can make giving care very difficult. Good communication skills involve good listening skills. Look at the resident, see what their body language is, and respond calmly and quietly. Do not overreact to impulsive behavior. As the stages progress, sleep habits do change. If the resident is having trouble sleeping, use short "rest" periods during the day, and keep the resident busy with activities while awake. It is easier to let the resident sleep whenever he/she wants to, but remember, if they sleep during the day, they will not sleep at night.
Sundowning is a special and difficult behavior. It is when the resident gets confused at the end of the day. The cause is unknown, but fatigue may play be a factor. A few tips to reduce sundown symptoms include soothing music, keeping the lights on and having familiar items in the resident's room.