About 10 years ago, I had the opportunity to work for a year in an outpatient mental health clinic in Dallas that specialized in the care of elderly veterans newly diagnosed with Alzheimer’s disease. The experience inspired me to pursue research in managing the cognitive and neuropsychiatric disturbances associated with dementia. During my two years of research, which included clinical work with patients and their families, I developed a profound appreciation for family caregivers who commit so much time and energy to their loved ones with Alzheimer’s disease.
Based on my years of observing and talking with these families, I became adept at preparing others for the challenging and sometimes overwhelming role of caregiver. After all, caregivers experience loved ones’ inexorable decline in memory and the ability to think clearly, communicate effectively, and take care of themselves. Sometimes people with Alzheimer’s develop behavioral and psychological problems such as anxiety, aggression, mood swings, or deep dissatisfaction—problems that can worsen as the disease progresses.
To get families ready for what is to come I always encourage them to educate themselves about the disease, stay focused on the person, cultivate patience, and set up a care plan that provides continuous supervision so the person with dementia is never left unattended.
I urge them not to try to stop or change their loved one’s behaviors, but to adjust to the changes and find ways to soften them. Here are other strategies I recommend.
Create a calming environment.
Dimming lights during meals may reduce agitation. Incorporating white noise—a constant and soft background noise—can decrease verbal agitation. Removing clutter may calm the mental or physical chaos people with Alzheimer’s disease sometimes experience. You may even find that a special blanket or piece of clothing can be comforting.
Communicate carefully.
Pay attention to sources of frustration and agitation—both verbal and physical. A person with dementia may have trouble processing information and not understand your attempts to reason with her. Instead, reassure her that she is safe and you support her. That may be as simple as holding her hand. When attempting to communicate, always approach from the front, identify yourself, and say the person’s name. Use simple words and provide one-step instructions or directions appropriate for the level of cognitive dysfunction; ask one question at a time. If your family member has trouble understanding what you’re saying, rephrase your message rather than repeating it.
Look for low-stress activities.
Find out if your local YMCA or YWCA or senior center offers classes in recreational, art, music, or pet therapy for people with cognitive impairment. These low-stimulation activities in an environment outside the home may help tamp down agitation and aggression or improve mood.
Be positive.
If your loved one becomes aggressive or angry, try to remain upbeat throughout the interaction. Keep your facial expressions and tone of voice peaceful and calm. This will help de-escalate the situation.
Stay safe.
Your safety and security are paramount. Before you take on a caregiving role, assess the situation to see if it’s something you can do on your own or if you’ll need help from an aide trained in caring for people with Alzheimer’s. As the disease progresses, you’ll need to reassess. At some point, you may need to consider transitioning your family member to a facility that can provide more comprehensive care.
Focus on the person.
As the disease progresses, you may want to tweak your strategies to make sure they meet your loved one where he is. Something that may have worked a year ago may no longer be appropriate. For instance, if he can no longer communicate, you may have to incorporate nonverbal methods such as music therapy or light therapy to communicate with and calm the person. Being flexible and open to change will make your interactions more successful.
Dr. Farinde is professor of pharmacology at Columbia Southern University in Orange Beach, AL. She also has experience in mental health, geriatrics, and pharmacy practice. She has worked with active duty soldiers diagnosed with traumatic brain injury and a psychiatric disorder. Born in Texas, Dr. Farinde enjoys running and watching classic movies in her spare time.