Caring Principles for Alzhemeir’s Patient

Principles of Optimal Behavior Management for Alzhemeir’s Patient

Most caregivers readily understand the importance of providing ongoing quality health care, nutrition, hygiene, and affection for their dementia patient. The following list of additional concepts will help caregivers minimize the burden presented by secondary symptoms in dementia.

Reward desired behaviors every time. This means simply a kiss, a touch, a smile, a thank you. To the greatest extent possible, ignore undesired or inappropriate behaviors. This means showing no emotion, not making eye contact, and not speaking of the undesired behavior.

Provide daily activities involving movement to music (dancing, marching, exercising, singing and swaying, etc.). A portable tape player and radio will prove very handy.

Foster any and all remaining skills that are appropriately independent. Let the patient help with tasks, however small, that he or she can still do. Avoid routinely doing things that the patient can do. Give no more help than is needed.

Choose some desired behaviors that are too infrequent, and work at increasing them. This is more likely to prove helpful than if you focus on decreasing some frequent, undesirable behaviors. Prompt, invite, and encourage the patient to participate in appropriate activities.

Simplify complex behavioral sequences into small segments. Eating a meal, for example, consists of sitting down at the table, picking up a fork, spearing the food, raising it to the mouth, and so forth.

Decide, based on your observation of the patient, what his optimal level of stimulation is, then try to provide it. Pay attention to lighting, noise, and the number of people around.

Foster routine by maintaining a consistent schedule and consistent way of doing things.

Whenever possible, avoid, delay, limit, minimize, and shorten the use of mechanical restraints, and (with physician approval) sedating medicines.

Provide multiple, redundant sensory cues. For example, to help the patient locate kitchen or bedroom items, cabinet doors and drawers may be labeled with pictures and names of the contents.

Modify the environment to improve the patient’s access to appropriate places and materials, and to reduce his access to inappropriate places and materials. This will increase the probability of appropriate activities and behavior. Use locks or spring latches on doors, drawers, and cabinets to prevent dangerous access; use labels and pictures to encourage access.

Never assume that a behavioral or cognitive symptom is inevitable and irreversible. Always search first for a treatable cause of the symptom. Daily possibilities to watch for include pain, hunger, thirst, and drug side effects.

If you cannot figure out why a certain behavior problem continues, keep a behavioral logbook. Record, each hour, what happened before and after each episode of the behavior. This will help identify hidden links between cues, behaviors, and rewards.

If you still do not know how to master a particular situation, call the appropriate specialist. This may be a psychologist, psychiatrist or other physician, nurse, or social worker. To locate such specialists, contact the appropriate department of the nearest university, major hospital, or medical school. Also, psychological and other professional organizations may be located in the yellow pages.

Caregivers must take good care of themselves, too. They should assertively seek the support, reassurance, and assistance of friends and relatives. Caregivers should educate themselves about dementia through reading and attending Alzheimer support group meetings. They should fully use the skills of knowledgeable professionals who are available to them.

Avoid confrontation with the dementia sufferer over any factual issues. If he or she holds firmly to an inaccurate belief or dislikes some facts which can be grasped accurately, the caregiver should not be drawn into arguments. Instead, the caregiver should -

Be noncommittal about the facts

Show empathy for the patient’s feelings