1Vie Alzheimer everyday with a person
Fighting against an amnesia-daily
Read the other chapters of this article:
2) What to do with this progressive amnesia?
3) With regard to the objects of everyday life
4) Marks, eating, drinking, sleeping ...
5) bright side relationship with the patient
6) Compensate disorientation in time and space
7) Techniques for guiding the patient to reality
8) Dealing with problems of knowledge (agnosia)
9) Dealing with speech (aphasia)
10) Facing the problems of the gesture (apraxia)
11) How to manage wandering?
12) Anxiety, irritability, delusions
13) Make a new dictionary of communication
What to do with this progressive amnesia?
Keep the memory returns to stimulate the senses.
Contain an "Alzheimer's" in a room by closing the door, is to isolate the sensory level. On the contrary, the use of brain function will stabilize his condition, slow the progression of the disease, making it more comfortable life of the person and his family. In this respect, the family remains the richest place for the stimulation of the senses. In it the memory of the group is registered: happy or sad events, the quarrels and illness, births and deaths, memorable anecdotes that are passed from one to the other ...
This is the best incentive possible. Provided that the love and affection are the heart of family care. This "treatment" begins with a smile, the hand that reaches out and takes, and then lands on the shoulder ...
About the objects of everyday life
- Do not lose the common objects
For the patient does not lose its better everyday objects:
- Add a cord to his spectacles
- Choose a handbag to a bright woman, a large key ring;
- Write his name and phone number on the bag, key chain, umbrella
- Make a card with his name and phone number in a pocket or a bracelet bearing the indication
s-state the brand, color and registration number of his car on the keyring.
- Prevent traders nearby: baker, pharmacist ...
Each piece is attached to an intimate memories happy: the alliance or engagement ring, the signet ring, etc ...
These objects have become over the years included in the body so that, when not worn, everyone feels a sense of lack. This means avoiding to deprive your father or mother.
The person who loses her jewels can be accused of theft of family, friends, staff, home from home. It becomes even more unhappy, aggressive. We can consider replacing the real jewels with fake, but said that the real will still be available for special occasions. Do not take the jewelry without regard to its opinion, explain, persuade, for its approval, show the location of the box is always better. (An agreement is essential to avoid loss of self-esteem.)
- The checkbook or credit card
You have to convince the elderly progressively to entrust his checkbook.
Show where it is placed, that it remains available when there is a check to do. Again: with patience, explaining, showing the location of storage. Always leave a little cash available to the patient. A person with Alzheimer's often aware of their incapacity. If he feels more wrong (abrupt withdrawal of checkbook, credit card) his moral will "take a hit" and influence the aggressive symptoms.
The emotion is key to maintaining good efficiency intellectual ...
Benchmarks, eating, drinking, sleeping ...
- Benchmarks = white pebbles of everyday life
Organize benchmarks for daily life
- He repeated often during the day's first or last name. Rename its proclamation, friends, family ...
- Do not change the usual place of business (razor, toothbrush).
- Have the clothes of the day, always at the same place, and in the right order of dressing.
- Leave all doors open, not locked in (and removing it, not lose it) that the minimum necessary for security. It is important not to turn the patient as a lion in a cage in one room.
- Let brightly lit places allowed, and in the dark places prohibited.
- Do not put up signs warning that when the patient complains himself of his disability, and with his consent. Better to suggest: "You want me to put up a sign so we know where are the shoes?"
- Rhythm of life
Organize the environment so that the person is not shameful after accidentally damaged or broken something expensive, etc.. Even if the spouse is patient it may cause disputes. Next, establish an order for daily tasks: time to go to bed, waking, eating assistance, help with bathing, dressing, visiting the toilet ·
- Rate this time of everyday life allows people to get used to an orderly life and makes it easier for the family. But this order is a means and not an end. This is not a "service order".
- Each time you change an event of daily life, this means for the person relearn and readjust. There is a need to do to boost ... But with patience, in small doses.
- Do not rush, do not rush the pretext of order. "Helping to make" not "do instead of" ...
- Set the axes of the general life of the person, not the details, not to turn it into a PLC. Pass on details to enhance his thought, acknowledge his mental effort: it has found the solution to what is a problem for her
- Facilitate dressing
A person with Alzheimer's forget the order in which threaded clothing. She makes mistakes while believing himself dressed properly. It can be a source of conflict with others. To avoid this, a minimum of psychology is required, and a good knowledge of the habits of others.
First example: a wife will be right to remind her husband codes of conduct and to struck a chord with him, saying: "Let your clothes are dirty. What will people think of me? Help me to change you! "
Second example: the man who turns to his wife he must also remember that it was still "prim" and perfumed. Hence one can note that will be said without bitterness: "You feel bad, I'm surprised you! Help me to change you."
Clothing should be placed prominently in the order they should be worn, and hide sleepwear. Use for linen of cotton rather than effects of synthetic as sophisticated as it may be: the patient sweats and does not know how to express it. As soon as assistance with dressing becomes necessary, it must accompany verbal gestures: "We will put the left pant leg."
Use as possible to the attachment type "Velcro" for shoes, clothes.
Ask the patient to participate in the maintenance of the machine: sort the laundry, folding towels, etc..
- Support at bedtime
In the presence of the person with Alzheimer's sleepwear put in evidence, close the shutters, draw the curtains, turn on the lamp, open the bed ...
These acts, repeated daily, are a ritual that facilitates the next stage of: "I lie."
Each person has a ritual for the acts of daily life. If we can perceive and reproduce the conditions.
Leave a night light on ... and always a pat or a hug and said good night!
- Addressing incontinence
To prevent urinary incontinence, we can try to create a rhythm to offer a drink and drive to the bathroom an hour later. However, it should not cause the patient to the toilet every hour if he did not drink heavily before. These comings and goings will be experienced as an unnecessary attack and provoke anger and denial.
Set the time to go to the bathroom is also a necessity: this avoids disappointment if a release is planned, or at feeding time. It is good to accommodate the schedules that were previously those of the individual.
- Assistance to the toilet
Cleanliness is the register of limited help.
Properly guided and stimulated, the patient must be able to make long familiar gestures, made daily over a lifetime. The price of this relative autonomy is slow. We must be patient by directing the movements, while maintaining the other hand a body contact necessary.
If the toilet is made by a third party, it does not start with the face but by the upper limbs (hands, arms). It is essential always to "speak the gesture" in progress "I will wash the left arm," "I'll dry the front" and maintain with the other hand skin contact. This contact must be skin to skin without plastic gloves, except for any private parts.
Benefit from the toilet to provide a massage the soles of the feet, hands, back, which secures. It's more of hygiene, it is a gift.
Drink. The sensation of thirst diminishes with all seniors. Dehydration can cause states of confusion and agitation. Drink plenty of water estindispensable. It is therefore beneficial to decode the "behavior of thirst" to provide drinking. Drink plenty is crucial: if no signs attract attention, offer to drink, often ...
Drink yourself to it, or drink with her if necessary. Use small bottles, already open and not too heavy. Other councils agevillage. Com fight against dehydration.
Eat. To recreate the desire to eat, have prominent plates filled with foods that are easy to grasp and eat (dried and fresh fruit in season, biscuits) associated with a glass of water or juice, and pecking self.
Sitting down to eat. Never eat while standing: the person does not see your face and can feel assaulted by a metal object - a spoon, fork, knife ... - Falling from the sky, or from hitting his upper lip ... whereas normally the first contact is with the lower lip. Place one end of the table, sitting by standing on the small side, gently take his hand press with a spoon on her lower lip.
Error. When the person uses an object by mistake (shoe to drink, fork instead of spoon ...), give it the proper object and back then the other, without exclaiming, without judging, without comment: she forgot the function of everyday objects. Any reflection can make it shameful, and develop its agresssivité upset.
To arouse the appetite, and run to fifteen or twenty minutes before eating a piece of cheese fat-free (type: cheese). This technique sometimes gives good results.
Bright side relationship with the patient
- Questions repetitive?
How to deal with repetitive questions?
- No need to answer: "I've already said", or "Do not ask stupid questions", "Stop asking the same thing"
It is better to refer the question: "And you, what do you think?" She often knows the answer: the question is merely the expression of a need for communication as a result of indoor climate.
ATTENTION PATIENT ACCOUNT GOES WHEN IT MENT
- Do not ask questions which are known to be unnecessary.
Say: "You have still not forgotten the name of the grandchildren?" Is guilt.
Or the patient has forgotten them and he feels a sense of shame, or he has recognized and then he expressed his contentment in his own way, by body language (his eyes light up and he takes the hand of her grand- children).
- About derogatory
Never take the negative things about a patient when he can hear
-Example: "It is like a plant." What the patient feels and understands is unknown.
- Importance of visits
Ask friends or relations to make her frequent visits, even if they are short-lived. "To give him news of the city."
Avoid mines buried
Avoid questions that can generate shame, "" Do you remember the day or ...?
Avoid anything that sad ..
- Accept the misunderstanding
When the person speaks a word without a clear understanding of his speech, not to rebuff. Listen to it by showing our presence from time to time by "well, well ..." or "oh well" or "it's true" ...
If she appears to pose a question, the expression of his voice, his face and his eyes should allow whether to answer yes or no. Or whether to appease a "do not worry, I'll do it, you'll be fine" and his attention elsewhere.
Compensate for the disorientation in time and space
Gradually, as the dementia progresses, the person with Alzheimer's disease lose track of time. She no longer knows the date, confuses the season ... It can ask the time ten times a day, automatically, without apparent reason. It can no longer tell his life chronologically. It can go to bed at 17 hours and shop at 23 hours. In the family, anxiety and psychological fatigue increases, "What will we become?"
Then, spatial disorientation occurs: the person comes out to go to a usual place (in her children, buy a newspaper, etc.). But it is difficult to find his way. She came home disappointed, sad and anxious.
A little later, it is lost on the way home ... and wondered, "Where am I?", "What am I doing here?", "Where do I live?" The day comes when it gets lost in his apartment, can not remember over-kill where if the toilet, the bathroom, where towels are hung and where the sheets are stored. She lost her business, does not dress well, do not wash well, does not know recognize the right of the left ...
By developing risk areas:
Travel: handrail adapted to facilitate travel, window lined with a strip of glass gives protection equivalent to a griddle, to open the window and see outside, open the exit door controlled by a keypad ;
Burns: electric stove hot plates instead of gas, with no dual system allowing maximum heat (burn hazard) if you press a button hidden; furnaces are one of the most important causes of burns and bearing fire; thermostatic mixing valve for hot water tempered to eliminate any risk of burning;
Various: electric water heater to avoid the danger of asphyxiation or explosion, the glass panel between the kitchen and the living room to a monitor when the patient is in the kitchen, you should leave the bathroom as bare as possible, and provide shampoo, towels, necessary for dental, shaving cream ... when the elderly person in need. With the evolution of the disease, even in the towel, soap, toothbrush and toothpaste can be used in ways that are inappropriate.
Attaching generalized grounded mat or using double-sided adhesive tape, not varnished floors, raised toilet grab bars and brightly colored shower with seat and retractable grab bars, and if the person bumps against the wall or against furniture, despite the good lighting, you can put reflective tape on the corners of furniture, along baseboards.
Introduction of time stamps
Free access to windows in order to follow the cycle of the sun and the seasons; simple clock with large numbers, clock chime, cuckoo, one month calendar display, or better, one day at a time.
Establishment of spatial cues
Report the toilet with a logo avoiding the letters "WC" (downgrading) to place markers bright night lights around the room and stay, do not change the location of furniture.
To decorate the walls experts recommend the use of straw yellow, orange (in the kitchen these colors excite the appetite) and red (door handles), most recognizable as blues and greens as the lens of the eye yellow.
Another trick is to establish a color contrast between walls and doors.
Techniques to guide the patient to reality
These communication techniques are used in institutions but can be practiced at home. They are intended to raise awareness of time, space and environment.
- "Hello, I'm Irene (or Robert ...) how are you this morning? By the way, what day is it? Yes, its already-media. Com-ment do you find the time? (Showing the win-dow). I'll help you dress for it will soon be 9 o'clock in the morning. "-
In short, you have:
- Established contact Verbal;
- Recognized that person as a human being in its own right by a simple dialogue, punctuated pause to enable it to respond;
- Avoided the set position of failure rather than appointing you forcing him to call you;
- Uses his abilities: he has a good chance of finding the requested date;
- Finally, you secure by presenting data that will help them know who he is, are those who speak what they will do for him.
Not to insist on the error
The person said Tuesday instead of Saturday?
In CUNE importance! Emphasize the error that we do not recognize the efforts provided by the patient. It understands the meaning of the question and tried to respond.
Example: - Do you know what season we are? - Answer. In summer (when it's winter).
- Reply to avoid: "Oh no! We are in winter, not summer!"
- Response Action: You too have been eager to be in but unfortunately we are still in winter ... Re-garde, the trees have no leaves.
Technically, both answers are correct, but the former does not reflect the effort and returns the error in the face. The second attempt to spare the patient by making him see that on the one hand, he is eager to be in summer, and, on the other hand, the reality is different.
Do not create a sense of failure
Correct errors without creating a sense of failure:
Example: your mother or your father gives you a name that is not yours?
You will answer: "From your smile, I see you recognize me. It happens to everyone in the names confused ... My name is ... "The error is corrected without the patient may feel guilty.
If the person is in a state of disrepair such that it can not meet, and if the answers are irrelevant, invalid or imprints of anxiety, it is better not to ask question. It should then reassure informing affirmatively or constatation.Vous it will hold that language such as "Look at this beautiful family photo! If I remember correctly, here is your daughter Liliane. It has its pro-medi-chain. And this is Jacques. It was he who ap-skinned yesterday. You have his picture on the table. You are a good grandmother to their children ... "
- Rebuilding the link with reality
Your mother or father refuses to reality?
Do not go against the words of the patient.
Let us be clear: this is not to acquiesce in a frenzy, but to build on the past to revive the weak son of communication.
For example, when your mother talks about her own mother as a person still alive, it would be a mistake to argue that she died twenty years. Better to confirm his words, but by focusing on feelings. Good repartee could be: "Your mother, you loved her very much?" Or, "How was your mother?" These are two questions rewarding for the disabled.
Say, "Your mother died twenty years ago" is the prerequisite for a "catastrophic reaction"!
Confront the problems of knowledge (agnosia)
A fork for soup?
The patient takes a fork to eat soup? Trying to drink from a pan-grammable? Poops next to the toilet? Met her earrings in the mouth and crunches ...?
When a patient fails to identify more objects, forget what they do, we must act slowly, the patient should be in line with its goal and then take the other, with a calm, normal, without exclamation.
Example: given a spoon by taking the range with which the person was trying to eat his soup to drink, by taking the slipper in which she was drinking.
It is also possible to make yourself properly to the action and catch the eye and attention of the person itself. When she looks at you, give the subject with a smile, without comment, without pejorative grimace.
If the emotional relationship with the person is good, if you won their trust you will come to correct and to relearn things as the days and months.
However, showing his exasperation at the slightest mistake, engaging in aggressive words or actions, resulting in unhappy and make the patient increases his réactios aggressive.
Warning: at the same time, do not fix it, or not to contact her and do everything in its place as dementia worsens.
Cope with speech (aphasia)
The sentences become inconsistent, the pronunciation is repetitive, the person can no longer be understood and become anxious, nervous. Who would not be in-saplace?
Suppose she needs the toilet: it locates the most, forgot the word "toilet" and the pressing need: she stirs and tries to make himself understood. Without suc-cess. Seeing gesticulate, you invite him to sit, calm down. After a while she will urinate or made under it. It may be ashamed and you Vou-Loir. If you reprimanded him, it will become more miserable, or aggressive.
Dealing incoherent speech or agitated?
Trying to decode a word related to, learning the code of the patient's nonverbal communication. Often when the person knows is understood, it is encouraged and dares to speak, ask questions. Once the message is passed, an oral reformulation facilitates its storage potential .-
Stand facing the person to read on the lips (better views if they are red);
- Speak slowly - very l-articulation.
- Accept that there are days and days without words.
- Living from day to day.
Warning: This is not because the patient does not respond he does not understand. The disease progresses, may mislead, give false hope or, conversely, allow the worst pessimism. The parent may respond well to the conversation and can at times make one or more correct sentences and well pronounced, and just respond with exact words. But he may lose the thread again, remember one thing today to be forgotten tomorrow, and vice versa.
Using the expression
The patient with Alzheimer's disease does not include the same as us.
- When you say "Open your mouth", he or she answers "Yes" ... but does not, "You want a cake" leads "No" answer ... but the patient takes the cake and eat it, "You want to go to the toilet" leads "No" answer ... and the pa-tient wets five minutes after.
Again, it is better to decode facial expressions that rely on an attempted speech. We must consider language as a riddle. Depending on the time and the activity of the person ... If she remained seated long, she may want to say she wants to walk, if she did not drink a long time, she is thirsty and so on.
Confront the problems of the gesture (apraxia)
The patient is not capable of complex and coordinated actions, like driving a car ouutiliser oven ...
Then he can not sign a check, dress himself, lighting a cigarette, close the door ... Again, we must learn to understand.
When gestures lose their meaning
The actions of the patient lose their ordinary meaning and the person no longer understands or has otherwise ours. His family also may not agree with what we expect, or with his words, his ideas.
- The patient can make the big eyes and pointing his index finger in a threatening manner, saying, "It's very good."
- Another, to find a lost word, shaking his fist, looked up and bites the corner of his mouth as if she was going to hit.
- A third can bite our fingers to show us his toothache, squeeze our throat to show she has a sore throat, eat a piece of paper saying "I'm hungry." Relatives can find these behaviors hopeless or even hostile. But this is false impressions.
Example: - When Joan opened her arms to embrace her father and that he turns away and goes, Jeanne is upset and guilty. She said: "He does not love me because ..." or "I have not forgiven ..." While, quite simply, his father did not understand, or misunderstood the gesture . We must therefore explain to family members, friends ... that their visit is important even if they feel will not be welcome.
It is important to know the same things happening again in the same situations, making it easier to understand. To express his desire to go to the bathroom, unbuttoning such person, the other strip, a third run in all directions, or massage her stomach ... Once we understand the meaning of the gesture and that leads them to the bathroom, they disappear.
How to manage wandering?
The wandering aimlessly is common in Alzheimer's disease. The person walking for hours and hours without end. She sits two minutes and then gets up to walk again, she pretends to sit down but left immediately ...
The stop to walk and force her to sit then attach cause agitation and anger. Walkers can cause a state of exhaustion.
Why this endless march syndrome?
No doubt, people express their anxiety, stress by walking.
Ambulation can sometimes be secondary to prolonged use of drugs .- Some nights, the person with Alzheimer's disease can not sleep: it is able to walk to work and store (or even out ) during the night. It must be left free in the house where the dangers are avoided. After being tired and under the influence of a sedative prescribed, it will leave everything to go to sleep. The next day, tired, she sleeps all day. "It takes days for the night ..." and it's very exhausting for the family - that does not sleep at night either - and is reluctant to locked in his room.
What to do?
Move person and walk with her in a park on the street or in a supermarket is an activity "therapeutic". Provided that the accompanying control the situation.
Consider also circular routes which bring gradually to the starting point and allow for easy back home.
To close the door of his room at night without worrying the patient, you have to hide from his eyes. A coat rack cleverly set above the lock and a bathrobe hanging masking the handle will fit the bill. The patient, unable to concentrate long on one specific thing, forget the handle and with it the idea of leaving the room.
Anxiety, irritability, delusions
Anxiety remains throughout the illness and cause of the agitation and even aggression in patients. The causes are varied.
One can anguished for her work in the middle of the night, trying to get dressed and rush towards the office. Family protests .- Reaction of the person: it can be angry or ashamed of his mistake, and sink into sadness. A woman may suddenly became anxious for the baby to have forgotten that she believes in her bed (she forgot her children grew up). She panics, trying to find, but does not know where to go, increasingly anguished .- If we force them to sit in not understanding what is going on in her head, she will s 'irritating: she defends her baby.
When the patient is anxious, he runs or walks constantly, constantly talking, manipulating an object for hours, doing everything he finds in his mouth and ... "She eats soap" - He who can not move pulls the sheets, buttons, clothes, hands and fingers, his slippers.
The patient may have hallucinations: hearing children and want to touch them, then there is nobody in the room and can see in the folds of the blanket as the forms of a snake, or start a frenzy of persecution, accusing one third of the fly.
The sick person drinks our anxiety as a blotting ink. Very sensitive, she feels if she communicates her anxiety, which increases his all .- The environment must be calm and confidence. The more the person will trust those who care for her, she will be less anxious .- Drink herbal teas to reduce anxiety. Calming herbal teas made from passion flower, valerian, hawthorn, can be used.
If the person playing with her sex, do not moralize, but give him something else to handle: a magazine, a toy, a string or cloth.
If a patient no longer recognizes itself in the mirrors, it is better to hide in a tissue.
Do not think the eye of a lost item. Offer an alternative activity. Better yet, set aside two objects that the person tends to wander to prevent it speaks of flight.
Identify areas where it piles up these objects.
Make a new dictionary of communication
A patient with Alzheimer's gradually going to lose all verbal references. It is therefore essential to learn to decode nonverbal behavior: task obviously difficult.
Observe the facial expression, gaze direction, tone of voice, posture, gestures excitement, the color of the face.
Search for expressions of pleasure or displeasure.
Isolate key words: face an incoherent, incomprehensible jargon to isolate the words that come to try to capture a sense.
Do not pretend to understand. Say what it is.
Choosing the right time: to solicit the cooperation of the patient, it is best to wait until it is well rested. Do not disturb him when he appeared absorbed in an activity.
Applications to adapt our capabilities: for example, allow sufficient time to the person for her to respond.
Do not put pressure, to interrupt or upset when she talks, this would only increase her distress. It is expected that the answers are slow growing, are less perfect or replaced by posturing.
Keep our promises despite impaired memory of the person. This is a human being who can, like us, be injured even if he can not communicate. Memory "emotional" sounds pretty well preserved in patients with dementia.
Speak in a calm voice with gestures soft promotes calm response from the patient. In contrast, a high tone and sudden movements may cause fear and mistrust.
Use the name of the person and his name to help themselves in relation to us.
Deliver one message at a time. Complete an action before moving to the next.
Do not give a directive or instruction at a time. Repeat the same words if necessary. Reformulation in other words the equivalent of asking to enter a new message.
Bring attention to the current action: If the person is distracted, if it deviates from the topic of conversation or if it abandons the current activity to begin another, it may be appropriate to remind him gently that she was saying or doing, and summarize the current connection.
Use the social rituals: greetings, handshakes, smiles, gestures are learned, eloquent and easy to understand.
Complete messages with objects or actions: use real objects, pictures, gestures, touch or text messages to illustrate a point. Designate the object by naming it increases our chances of being understood.
To confirm the person we are trying to grasp its message, it is worth repeating some of the words it uses. Such recognition reassures her and shows our attention.
Avoid open-ended questions (why? How?): Prefer those with an alternative: "Do you want milk or coffee?"
Simplify the issues to allow the answers "yes" or "no". If the person shows a marked deterioration, the questions can be replaced by affirmative statements such as "Here is a fruit". This practice succeeds best when we know their tastes and needs.
List the words and gestures that meet the person, when communication becomes more difficult, it is an alternative way to generate a response.
Precede it with a simple explanation for each intervention involving physical contact or manipulation of objects belonging to the person. Review needed.
Introduced gradually, information can be integrated by the patient, reducing the fear. Example: - Step 1: "We're going to dinner." - Step 2: "We're going down the corridor" (cross the threshold) - Step 3: "Down the hall is the dining room" (once in the hall) ... etc..