The aging process is a natural part of life that everyone undergoes. It is a process of change. As we age our bodies show this change in various ways: hair color, skin changes, muscle tone, and in a slowing and weakening of bodily functions. Advancing age may bring about subtle changes in memory as well.
Dementia is the loss of intellectual abilities (such as thinking, remembering and reasoning) of sufficient severity to interfere with a person's daily functioning. The most common form of dementia is Alzheimer's disease. Alzheimer's disease is a progressive, degenerative disorder that affects tissues in the brain, eventually resulting in abnormal brain function. In 1907 German physician Alois Alzheimer first described the abnormal changes in the brain now associated with Alzheimer's disease.
As there are more than 50 diseases that can cause dementia or symptoms similar to Alzheimer's disease, a thorough medical evaluation is needed to be certain. Currently there are no definitive tests that can be done to diagnose Alzheimer's disease; rather, a series of tests are conducted to rule out other causes of dementia that may be treatable. There are several cognitive tests that can be done that are about 90% accurate in identifying people who have very mild dementia. New advances in MRI testing also help detect early onset of Alzheimer's and may someday be able to predict the disease before a person ever experiences the first subtle confusion. Recently researchers have been experimenting with blood testing such as Presenilin, which can identify an early onset gene, and AOE, which can tell you if you are high or low risk for contracting Alzheimer's disease.
People with Alzheimer's disease experience many common problems associated with their dementia. While not all people experience the same problems, there is a thread of commonality among them. Here is a breakdown of a few challenges and ways the caregiver can support the older adult:
Challenge: Short-term memory loss is normally the first symptom noticed. Patients become forgetful, lose things and have trouble remembering most recent events.
Suggested Support: Establish a routine and provide a written daily agenda such as notes or a special calendar. Leave items in plain view that are used daily such as hearing aides and glasses so that they can take advantage of visual cues. Avoid questions that test their memory such as "What did you eat for breakfast?" or "Didn't you pay the credit card bill?" as these serve only to make them more painfully aware of their loss.
Challenge: People with dementia often experience problems finding their words, especially when they become fatigued or are emotional.
Suggested Support: Supply the word if the older adult loses train of thought mid-sentence. Tell them they can come back to it later. Preserving the patient's self-esteem is critical.
Challenge: Some people may have difficulty following instructions or complex concepts.
Suggested Support: Use short sentences, and visual cues. Never assume that they have understood everything you have said.
Challenge: Many people will ask the same question repeatedly.
Suggested Support: This is quite common and indicates that they are trying to remember something that is important to them. Be patient, and answer their question as if it was the first time you heard it. If the information is critical, jot it down for them.
Challenge: Denial is a common coping mechanism and a natural way of self-preservation.
Suggested Support: If you want someone with dementia to admit that they have it, they need to feel safe, supported and that they have some control over their future. Resist the temptation to convince them of their condition. They are more likely to respond to emotional support and opportunities to talk about their fears.
Challenge: Changes in the brains of early stage patients cause impairments in memory, reason and judgment, rendering it difficult for them to make decisions. Many feel overwhelmed when asked to make choices, causing them to feel ashamed of their condition.
Suggested Support: Limit situations where choices are necessary.
Challenge: Paranoia, common in the disease, results from damage to the part of the brain that separated fact from fiction. It is also a way for the patient to avoid the painful realization that they have Alzheimer's disease.
Suggested Support: You will not convince an Alzheimer's patient that someone didn't take his wallet, so don't even try. Respond to the feeling behind the paranoia. Help him look around for it. Avoid denying their reality.
Challenge: Eventually the time will come for the older adult to turn over the car keys. For many adults, driving represents independence, freedom, competence and control. It is a way to access healthcare, buy necessities, be productive and stay connected to family, friends and the community. Concerns about driving are likely to surface during early stages of dementia, when individuals are still socially engaged and able to manage other daily activities. Giving up driving can be a deeply personal and emotional issue. Disorientation and changes in memory, visual perception and reaction time make driving dangerous for both the patient and everyone else on the road.
Suggested Support: The family should closely monitor their loved one’s driving abilities. If they have concerns, they should have their doctor tell the older adult that they can no longer drive. In most states the Department of Motor Vehicles can offer a competency test as well. Opening conversations early in the disease about when driving should cease can help smooth the transition to not driving in the future.
Challenge: Newly diagnosed seniors commonly experience depression. Symptoms of this are often associated with withdrawal: crying, agitation, changes in eating habits, changes in sleeping patterns, feelings of worthlessness, and acting out. Depression can significantly lower a person’s cogitative capabilities and their ability to fight off illness. Ultimately this is the single biggest factor that will influence their quality of life.
Suggested Support: Depression is treatable with antidepressants, but the best treatment for depression is socialization. Isolated people with dementia tend to focus on all the things that they can't do anymore, their limitations. But in social situations such as adult day services or senior living homes, their focus becomes directed outward toward their environment.
Challenge: A patient who is kept in the dark about the source of their problems may tend to worsen because they desperately try to remember things and become frustrated, agitated and possibly depressed when they cannot. Families are often concerned that knowing what is causing their loved one's memory loss may trigger them to panic or become depressed and hasten the degenerative process, while for many the opposite may be true.
Suggested Support: Seniors who can learn to view changes in their life as a process of life rather than an end to it will live happier, healthier lives. They need to know that something is causing the problems that they are experiencing and that it is not normal or a part of getting old. This way they can learn to understand the disease and their prognosis and be more receptive to the adjustments in their changing lifestyle.
Challenge: With the progression of Alzheimer's disease or other dementia, the patient may become increasingly dependent upon the caregiver for even the most basic tasks. Daily activities once performed routinely may require assistance or supervision by the caregiver.
Suggested Support: The caregiver may eventually need to reconsider the range of acceptable activities for the patient as their impairment progresses. The management of financial affairs and previously safe activities such as driving, preparing meals, taking medications and going for unaccompanied walks may become hazardous. In later stages of the disease, matters such as daily hygiene and dressing may be beyond the capabilities of the patient and will become the caregiver's responsibility.
Even though a diagnosis may be hard to accept, for some people it may come as a relief. The ability to identify a particular physical disease may allow the patient and the caregiver to better understand and respond to the changes they are seeing. Early diagnosis can be devastating to those who have the capacity to understand the meaning of their diagnosis, but can help equip those involved to understand the disease process and make appropriate plans for their care.
For more details on how you can support a loved one who has been diagnosed with Early Onset Alzheimer's, contact Rye at Evolve today .
Benjamin Pearce is an expert in the senior living industry and dementia-related care. He has thirty-five years of experience working with over 200 communities in 36 states encompassing over $1 billion in annual revenue. Pearce has extensive experience as a published author of several books and as a public speaker for caregivers and supervisors. His book, Senior Living Communities: Operations Management and Marketing for Assisted Living, Congregate and Continuing Care Retirement Communities is the go-to handbook for effective senior residential facilities. It has also been converted into an online classroom for the certification of assisted living administrators in several states. He is also the author of 27 eBooks on Amazon Kindle and iTunes covering industry related topics. He is a frequent contributor on senior living for publications such as Provider, Contemporary Long Term Care and Assisted Living Success. Pearce also serves as an expert witness for assisted living and skilled nursing litigation. Pearce shares his expertise as an adjunct professor for Johns Hopkins University and New York University, while teaching a variety of courses about senior living development and operations. He is also a professor at the Institute for Senior Living Education, based in Connecticut, an instructor for the Executive Director Certification Course and an instructor for EasyCEU.com, a continuing education provider. Pearce has received a number of awards including the Contemporary Long Term Care Order of Excellence, awarded to recognize outstanding operators and an elite fraternity whose members have been judged by their peers to be the nation's best.