My Patient Has Alzheimer's: General Guidelines

by National Institute on Aging

(Page 2 of 3)

For an Alzheimer's patient, the trauma or ailment that preceded hospitalization, the strange new environment, the disrupted daily routine and the influence of medications can all be factors for increased confusion and decreased ability.

There are a number of things you can do to reassure your patient. You should:

Provide a consistent, predictable routine. Ask the primary caregiver for the patient's usual routine and follow it as closely as possible. Encourage the use of security objects from home (i.e. favorite pillow or quilt). Provide care by the same nurses and nursing assistants as much as possible. Avoid surrounding the patient with several doctors and medical students at one time. Evaluate the patient for sources of potential pain and discomfort. Even though he may be experiencing pain, the patient will probably not verbally complain. When possible, schedule tests at a time of day when the patient is at his best and not fatigued. Discontinue asking orientation questions once the patient's level of comprehension is established. Use good communication techniques. (See Communication Section). Schedule at least two rest periods: A half hour after morning care and an hour in early afternoon. Rest is important! Post rest period times on the patient's door. Use a big "Resting" or "Do Not Disturb" sign during the actual rest period. Limit visitors to one or two at a time. Cue the patient for sleep by darkening and quieting the room. Avoid using physical restraints. They do not prevent falls. Injuries from falls while the patient is restrained are often more serious.

Room Service: Assessing the Environment

Avoid numerous room changes. Change increases confusion and anxiety. Avoid placing the patient in a room located in a high noise, high traffic area. Keep the television off until the patient turns it on or requests it. Remove artwork containing people or animals if the patient interprets them as real-life intruders. Keep lighting as free of shadows and glare as possible. Avoid clutter. It can increase confusion, agitation and the risk of falls. If the patient can understand written words, then large, bold lettered signs can serve as cues to the bathroom, closet and personal items.

Providing the Essentials: Comfort and Safety

Comfort

Always communicate a sense of security, caring and respect. Each staff/patient interaction should include: touch, eye contact, orienting information and an activity the patient can successfully perform. Eyeglasses, dentures and hearing aids can enhance the patient's communication. Offer to assist the patient with placement of these devices. Be aware in some instances the patient is more comfortable without them. If the patient has a comfort item, something that makes him feel secure, make sure it is within reach.

Safety

Provide a safe, structured environment and consistent staff to attend the patient. Place the patient in a room that allows easy and careful observation. Place bed in low position. Don't leave anything at the bedside that might harm the patient. Elopement precautions: Place the patient in a room where he has to pass the nursing station in order to reach an exit. Have a photo of the patient on file.

Positive Approaches To Personal Care: Activities Of Daily Living

Eating

Do not ask the patient to fill out a menu. Ask the family about food preferences. Simplify the food tray. Keep small, colored dishes on the unit to allow for smaller portions and the ability to offer one or two food items at a time. Smaller, more frequent meals may work better for the patient than the standard three large meals. Cueing the patient to eat by using verbal reminders along with a light touch to the forearm increases food intake. Finger foods, cups with lids and broad-handled utensils may make mealtime easier for the patient. Late stage patients may chew, but need frequent reminders to swallow. Plate guards and bibs with pockets catch spills and protect the patient's clothing. Offer the patient fluids frequently throughout the day. Ask the caregiver what the patient prefers to drink and the type of drinking container used at home.

Oral Hygiene

Brush the patient's teeth at least twice a day. For less impaired patients, apples and other fresh fruits aid with oral hygiene.

Bathing

Bathe the patient at his "best" time of day. If possible, bathe the patient at the time he normally bathes at home. Avoid using the shower. A hand-held showerhead provides better control of the water. Allow the patient to do as much as possible. Break down the task into simple steps using verbal and visual cues. When assisting the patient, give the bath slowly. To avoid agitation, tell the patient what you are going to do one step at a time. Use soft music, talking or snacks as pleasant distractions. Keep the patient warm! During a bed bath, cover body parts except the parts that are being washed. Sounds amplify off tile walls. Running water can sound frightening. Be flexible. A "bird bath" may be more acceptable to the patient.

Toileting

Clear a path to the toilet or commode. Place bed in view of toilet. To help cue the patient, place a picture of a toilet or a written sign on bathroom door. Place your patient on a two-hour toileting schedule. Use a nightlight to make it easier for the patient to find the toilet in the middle of the night. Observe your patient for constipation. Ask questions about abdominal discomfort. Watch for non-verbal signs of discomfort such as grimacing or clutching. Do not ask the patient if he has had a bowel movement.

About the Author

www.nia.nih.gov
NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.