Late Stage
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Memory impairment; forgetting familiar people and things
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Decline in physical activity and mental condition
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Unable to communicate effectively
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Unable to handle daily life
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Long-term care is required
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Biological clock confusion
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To avoid suffering from cerebrovascular disease, should prevent and control diabetes, hypertension, heart disease and stroke
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To establish a healthy lifestyle:
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Choose foods which are low in sugar, salt and oil, high in vitamins and protein foods, and maintain a balanced diet
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Have regular exercise
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Avoid smoking and heavy consumption of alcohol
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To maintain a remarkable life
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Broaden social life, connect with people and share with family and friends
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Develop healthy hobbies and personal interests to stimulate brain functioning
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To undertake examination early and seek help
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To maintain a cheerful mind, and adopt an appreciative and thanksgiving attitude to life
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To use the brain more often and have the courage to accept new things
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Do more brain exercise to prevent brain decline
Dealing with emotional and behavioral problems
About 90% of patients with Alzheimer's disease have behavioral problems, and these "non-functional behaviors" are divided into psychological and physiological aspects. The former includes depression, anxiety, delusion, hallucinations, while the latter includes attacks, excitement, insomnia, screaming and wandering. Causes of these behavioral problems include:
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The patients may be under pressure when they have difficulty to cope with the task/work in front of them;
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They may become frustrated when they interpreted messages incorrectly;
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Such behaviours may be caused by other potential diseases.
These behaviours may take place without warning, causing concern to both the patients and the carers. However, carers may be able to find ways to prevent or address the causes of such behaviours by, for example, recording each instance and what happened before and the time at which such instance took place. Bear in mind that each patient is an individual and he or she may react differently to the same situation.
Emotional problems
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Reduce the pressure on the patient from the external environment
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Provide a quiet, stress-free environment and simple instructions familiar to the patient for avoiding emotional problems
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Approach the patient with ease and in a slow pace, so as to avoid imposing the carer’s own stress and anxiety on the patient.
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As the patient may not recognize everyone, do try to mention your name and relationship with him/her at the time of contact.
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Keep eye contact and proper physical touch with the patient. Address the patient by a name familiar to him/her.
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Adjust the environment
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Be aware of circumstances which may give rise to emotional problems and prevent such problems from re-occurring as far as possible. Carers may use a log to record such instances for monitoring.
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Make the best use of the environment to address emotional problems, such as by taking them out for a walk in a safe place when they wish to move around.
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Build a well-structured, comfortable, personalized and user-friendly environment for the patient.
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Simplify the layout and decoration as far as possible and use bright colours.
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Avoid changing the living environment, such as moving to a new place, as it may worsen the patient’s emotional problems.
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Distracting attention
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When the patients’emotion is unstable, pacify them with comforting words, and then distract their attention to relieve the tension. Be generous with praises for positive change of behaviours and signs of cooperation.
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If the patient is in a safe environment, the carer may temporarily not to deal with the patient’s anger, retreat for a while or ask someone else to take over.
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Allow the patients to do things that they really enjoy and chat with them on these subjects. Be always ready to come up with praises and encouragement.
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Tips
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Do not argue with persons with dementia, especially when they are depressed or upset as they are incapable of remaining rational.
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Stay calm and refrain from expressing negative emotions
Behavioral problems
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Causes for aggressive behaviours
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Defensive behaviours: When patients are in an environment where they need to be helped or when their independence and privacy are infringed, such as taking a bath or going to the toilet, they feel insulted and frustrated and so may react with anger.
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Incapability: They feel frustrated when they fail to manage or complete certain tasks.
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Feeling misunderstood and embarrassed about what is happening: They may accuse others for stealing their belongings because they cannot find the objects or they are unwilling to admit that they have forgotten where they have put those things.
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Fear: If persons with dementia cannot recognize where they are or the persons they live with, they will be shocked with fear. They may convince themselves that they are in another place (such as a friend's home) or the people around them are strangers. Apart from that, any sudden sound or anyone coming from behind can cause them to react with hostility.
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When something unusual happens, such as the visiting of a large group of people, or the presence of disturbing sound or activities, they will have difficulty to adjust and would not know how to cope with the situation.
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When the patients are bored, frustrated, frightful or when they are suffering from certain illness and pain, especially when they have difficulty communicating with others through words, they may express themselves through anger, attacks and emotional outbursts.
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When they are being stopped form doing something, they may feel fearful and angry.
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Handling aggressive behaviours
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Sometimes a patient becomes aggressive and may use more violent language to hurt people. At this time, the carer should stay calm and do not show sign of fear. Try to understand that although the attack appears to be directed at you, it is not a deliberate personal attack.
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When the patient is in a good mood, it is good to arrange for him or her to participate in some constructive activities within his or her capability. Watch out for any change in the patient’s emotions, which is an effective preventive measure.
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While the activities arranged for the patient should be within his or her capability, do not expect too much from the patient. If the patient becomes inpatient for not being able to do well, adjust the level of difficulty of the activity and give every encouragement for even the slightest achievement.
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Let the patients complete some tasks which they can do by themselves, even if it may take a long time. This is an encouragement for them to complete a task independently.
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Enjoy some refreshments together with the patient especially something he really likes. That will help distract his attention. Sometimes, the carer could be the reason for his emotional outburst and the carer should stay away for a while until he calms down.
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The patient's temper may be caused by physical discomfort like inflammation in some parts of the body. If there is such a possibility, must consult the doctor.
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If aggressive behaviours occur and are becoming frequent, should consult a doctor as control by drug may be required and the patient should be put under close observation.
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Prevention of unattended home exits
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A lock may be installed at the front door which can be opened on both sides. The carer must remember to keep the key at all times.
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The lock can be installed at location which the patient would not expect.
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A doorbell or sensor can be installed at the main gate, which produces a sound when the door is opened. This will alert the carer that patient has gone out.
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Make sure that the design of the garden or terrace is safe and make it a "secured zone" for the patient to walk around.
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Allow the neighbours and security staff know that there is family member with dementia and ask them to inform the family if he or she goes out alone.
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Handling patients accustomed to nighttime unattended home exits
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Provide a tranquil and restful environment for a good sleep.
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Increase the patient's daytime activities to make him tired and sleepy at bedtime.
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Let the patient drink a glass of warm milk or listen to some soft music before bedtime so as to make him fall asleep easily.
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If the patient wakes up at night, let him know that he is safe and where he is. For example, put some objects familiar to him in the bedroom and install a small night light to make the room adequately lit to reduce fear.
Tips for communicating with persons with dementia
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Keep your voice soft while speaking, but make sure the patient can hear you well.
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Words are not the only means of communication. Should also focus more on nonverbal communication modes, such as body contact, speaking tone. When the patient shows signs of not understanding what is said, the carer can use body language to assist.
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Be always ready to listen actively and be empathetic in understanding the emotions and feelings of the patient.
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Speak slowly, keep the sentences short and concise, only talk about one thing at a time. Also, can talk about things that the patient can remember more easily, or things that he encounters every day, such as date, weather, etc.
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Ensure that the patient is not subject to noise disturbances from radio, television, etc.
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Provide the patient with appropriate eyeglasses, hearing aids and other aids when needed.
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When talking to a patient, do not change the environment frequently. This will help reinforce the patient's trust in you.
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Allow the patient sufficient time to understand what is said and to make a response.
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Try to use different expressions to convey your message if needed.
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During the conversation, enable the patient to know where he is, what is happening around him, who he is, etc. to enhance his sense of security.
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Always refer to names familiar to the patient, such as “your son Siu Ming” instead of just “your son”.
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Focus more on the expression of feelings rather than the content of conversation.
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When the patient repeatedly ask the same question, do answer him tactfully and avoid making impatient responses such as "you have asked the same question many times", etc. A carer should repeat the answer patiently and provide other prompts, such as writing the answer on paper, in front of the patient.
Relevant websites and articles
