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Alzheimer’s disease patient care

Alzheimer’s disease essentially consists of the death of certain neurons in the cerebral cortex in a gradual and progressive manner over the ten years that, on average, the disease lasts. Neuronal death with a cause that has not been definitively clarified is called neurodegeneration. This is why Alzheimer’s disease is said to be a neurodegenerative disease. Organize the living space in your home Gradually, room by room, problem by problem. Don’t try to solve everything at once. Avoid sudden changes that may increase the patient’s feeling of insecurity. Avoid falls. It is advisable to remove or fix rugs and mats to the floor, especially in the bathroom and bedroom. Shorten electrical cables so that they do not drag on the floor. Remove furniture with protruding spikes or glass (pad any protrusions). Replace unsafe chairs or those that are difficult to get out of. Remove obstacles or objects that may hinder passage in aisles or narrow places. If you have stairs, fix anti-slip strips over the edge. It is advisable to place a barrier at the top and bottom of the stairs to prevent passage. Make sure that the rooms have good lighting during the day and are equipped with a lamp during the night. Avoid accidents. It is recommended to lock up electrical appliances (blender, sharpener, lawnmower), matches, lighters, firearms, car keys, toxic products (bleach, medicines…). Remove interior locks to prevent the person from locking himself/herself in. Doors leading to the outside and windows must be fitted with a safety device that prevents them from being opened without assistance. Do not let him/her pick up small objects (needles, buttons, etc.) that can be swallowed. Radiators should be fitted with a protective grille. Regulate the water heater to avoid possible burns. Keep an eye on particularly dangerous places, such as terraces, poolsides, cars. Inform your neighbors of your relative’s condition so that they can help you. Wear a bracelet or medal with your name, address and phone number on it. Have a recent photo on hand that can be circulated in case of loss. Bedroom organization Remove all ornaments, magazines, etc., that are likely to distract him/her. Secure the lamp on the bedside table so that you can turn it on and off without knocking it over. Secure the bedside rug to the floor. Install a pilot light that stays on during the night. Luminescent strips can be placed to show the way from the room to the toilet so that the patient does not get lost if he/she has to get up at night. Position the bed in such a way that the patient can get in and out of it without discomfort from either side. Clothing In the closet, you should keep only the indispensable clothes of the corresponding season of the year. Do not let the patient choose, choose for him/her. Choose clothes that are washable and do not require ironing. Choose clothes that are easy to put on and take off: Velcro fasteners, closed polo shirts, shoes without laces, socks without heels… Identify the clothes in drawers and closets with small signs or drawings. Other tips Avoid noise and confusion. Turn off the TV or radio at the end of the broadcast. Avoid loud music and always respect the patient’s tastes. Remove or cover mirrors. When you see yourself, you may not recognize yourself and this may cause you distress. Keep only everyday objects in the same place. Place a large clock that you can easily see, as well as a calendar on which you can mark the days. Mark the routes, for example, from the bedroom to the toilet. They will feel better. Use simple picture signs to remind him where things are. Put a blackboard on the wall (always in the same place) and clearly write down what to do (never too much) when you leave. Bathroom and personal higiene The bathroom medicine cabinet should be locked and free of medications. Equip the bathtub or shower with non-slip strips or mats, in the same color as the floor if possible.

Try to put bars on the walls of the shower to help you get out. Also next to the toilet. The bathroom should have some light on at night. Bathroom items should be kept to a minimum (1 towel, soap, 1 toothbrush, and tube of toothpaste). Other items (razors, etc.) will be provided when needed and then collected. Things should always stay in the same place so that you do not have to look for them, just pick them up. Place the bath mats only for when you get out of the shower. Body hygiene For bathing or showering, build on your previous habits to create a routine (time…). Take your time and don’t rush your hygiene routine. Prepare the bathtub before him/her is in the bathroom. Avoid filling the bathtub. Too much water can frighten him/her. Control the temperature. Do not add bath gels or foams that can make the bathtub slippery. Always follow the same steps: pick him/her up and take him/her to the bathroom. Ask him to take off his clothes in an orderly manner and name them one by one (skirt…). Ask him/her to lather up and then rinse. If he/she doesn’t, wash him/her gently and slowly. Help him/her to get out of the bathtub. Give him/her the towel and ask him/her to dry off. Give him/her the clothes in order and one at a time. Take advantage of the bath to check the condition of your skin (reddening at support points), nails (both hands and feet), mouth care (teeth, prostheses, etc.), and intimate hygiene (to avoid irritation and infections). Hair: short hair is preferable. Do not wash his/her head in the bathtub and do not use hairdryers. Makeup, especially if previously used. To avoid circulatory, muscular, and joint problems, it is necessary for the patient to do some daily passive gymnastics of feet and arms and at the same time to be given rubs to promote circulation. Organize his/her kitchen and food The stove (especially if it is a gas stove) and the oven should be left unused when not in use. Lock the heater in the middle position to prevent water from coming out too hot. It is advisable to install smoke and fire alarms. The refrigerator should be locked or padlocked. The floor: keep it dry to avoid falls. Cleaning products should be kept under lock and key. Keep knives and sharp objects out of reach. Equip yourself with unbreakable crockery. There are dishes with suction cups to fix them to the table that prevent them from tipping over. Use a plastic tablecloth and plates of different colors so that you can distinguish them well. Make sure that the plates are larger than the food portions. Your food Organize meals as routinely as possible. Always have your child eat at the same time and in the same place. Reduce cutlery to a minimum and give him the appropriate ones at all times. Put a bib that fastens behind the neck. Put the plates in succession, never together. Provide a calm environment, do not force him/her. Try to persuade him/her affectionately. There are foods that can be eaten with the fingers. It is preferable for the person to do as much as he/she can by him/herself. Take into account his or her previous tastes. Establish a list of dishes that cover all meals for a week trying to vary (one day chicken, one day fish,). Recommended foods: Rich in protein: red meat, oily fish, eggs, milk, and fresh vegetables. They can also take some fats, such as olive oil. Rich in vitamins: vegetables, fruits, vegetables… Rich in fiber. Do not give them too much: carbohydrates, fried oil, strong cheeses, or pre-cooked foods (they have preservatives and harmful dyes). Cut food into small pieces. Watch what you drink during the day. Do not fill his/her glasses to the brim. If he/she is afraid to drink, it may be helpful to give him/her the drink from a bottle. If it is coffee or tea, check the temperature of the drink. Avoid alcohol. Use water, fruit juices, or milk. If the patient does not open his mouth, you can touch his chin or jaw gently or put liquid or food in his/her mouth to remind him/her of the act he/she has to do. If the patient has trouble chewing, demonstrations can be given. In general, imitation works. If after eating the patient forgets that he/she has eaten, have a tray with biscuits, cookies, etc. ready.

On the patient’s behavior Always check what he/she says: whether he/she has eaten, put out a cigarette, or turned off a tap, for example. When faced with repetitive questions: there is no point in reasoning. Answer briefly and in terms of activity (for example: “what time is it…?” “lunchtime”). When faced with overreactions: look for the possible cause and remedy it. If it is due to fear, consider him/her as a child, hold his/her hand, tell him/her that you love him/her, and do not move away from his/her visual field. Comfort him if he is sad. If it is aggressive behavior, stay away, but in a way that he can see you. His aggression will subside and he will forget why. Forget it yourself, too, and don’t complain about it to him. Never scold the patient. He/she doesn’t know why you do it. Never argue. If you want to change any of his/her behaviors, choose only one and try to get the rest of the people to support your position. Be aware that the patient may take your initiative badly. Continue with your idea in spite of their hostility. Persevere. The results take time to manifest themselves. Find a substitute complement: a person who can help the patient. Activity that the patient likes to do (occupational therapy, music therapy, memory stimulation, psychomotor skills…). Repetitive walks: let him/her do it. Leave a room in which he/she can walk without hitting himself/herself. Plan for walks. On nocturnal behavior Plan a long walk during the day to give him/her exercise and tire him out. Always at the same time and afternoon. Avoid or reduce the amount of daytime lounging. It is good to drink warm milk or herbs before bedtime to relax. If you find him or her wandering in the middle of the night, tell him or her who you are. Speak softly and gently. Talk to him or her face to face. Remind him or her that it is nighttime and everyone is asleep. Write down the times he/she usually wakes up so the doctor can give him/her the most appropriate medication to prevent insomnia. Improving communication When he/she speaks: when he/she has difficulty finding words, ask him/her to point to things and name them instead. Make sure you understand what he or she is saying and confirm it. When using one word for another, do not correct him/her systematically. When he or she stops in the middle of a sentence, give him or her time to finish it. Repeat the last two or three words he/she has said to help him/her. If he/she doesn’t get back on track, change the subject. If he/she uses phrases or single words out of context, try to capture his/her thinking based on the situation at the time. When you talk to him or her: It is important to talk to him/her a lot. The patient will pick up on your feelings from the tone you use. Lower the tone of your voice. Don’t shout. Speak slowly and pronounce words clearly. If the TV or radio is on, turn down the volume so they are not distracted. Avoid complicated language and long sentences. Use short words and simple sentences. Tell things as they are and do not explain. When you ask a question, keep it simple, avoiding having to choose. Give him/her time to answer and check if what he/she said is accurate. If he/she does not respond, ask the same question again. Ask him/her things politely and calmly, this will put him/her in a favorable position to respond. Get in the habit of telling him what you are doing. Say things in a positive way, never in a negative way. Prepare small reminder lists so he/she knows what to do (in capital letters and not too many notes). If his/her condition is more advanced, you can use drawings to point out where things are. A language that the patient will understand for a long time is to smile at him/her when he/she looks at you. Show him/her by gestures what you want him/her to see and what you want him/her to do. Show him/her through gestures what you want him/her to do. He will, predictably, imitate you. Urinary and fecal incontinence Rule out that there is another origin other than the disease. Adapt his/her clothes so that he can easily take them off when going to the toilet. Take him/her to the bathroom as soon as you see him/her fidgeting or pulling on clothes, he/she may have forgotten where the toilet is. Accompany him/her to the bathroom every two to three hours to urinate. If he/she is not coordinated enough to sit on the toilet, help him/her and you may need to install a special toilet that is high. Have a potty available if he/she can’t get there in time. Try to find out how your family member expresses the urge to urinate or defecate. Tell other caregivers. Prevent him/her from drinking two hours before bedtime and take him/her to the restroom before putting him/her to bed. Place a waterproof sheet to protect the mattress. If incontinence becomes permanent, purchase adult diapers. Be careful not to leave the diaper wet for too long, as there is a risk of skin lesions. To avoid this, wash the genital area in the morning and at night. Take the opportunity when undressing to check that there is no irritation or redness. Make sure to keep your skin clean and dry. If you notice any abnormalities, consult for the use of talcum powder, ointments, etc… Caregiver Find out about everything related to the disease and its evolution, as well as how to cope with social and economic situations and the existence of associations. Join associations of Alzheimer’s patients’ families to help each other. Rest, even if the person who replaces you does not provide the same care as you do. Take a vacation, even for a few days. When you are nervous or in a bad mood, it is better to let someone else take care of the patient. Keep up your leisure activities. Make time to watch some TV programs, window shopping… Keep your friends, explain the illness of your relative, and make them understand the situation. Avoid alcohol to cheer yourself up. Do everything you can to maintain your own health.

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