PNW 314 • Revised March 2016 A Pacific Northwest Extension Publication Helping Memory-impaired Elders A GUIDE FOR CAREGIVERS OREGON STATE UNIVERSITY n WASHINGTON STATE UNIVERSITY n UNIVERSITY OF IDAHO Contents “Senility” versus “dementia”.................................................................. 3 Causes of dementia..................................................................................... 5 The family’s adjustments......................................................................... 6 Self-care for the caregiver....................................................................... 8 General caregiving guidelines.............................................................. 14 Responding to challenging behaviors..............................................19 Approaches to specific problems........................................................ 22 Communicating with the memory-impaired person................. 33 When it’s time to move on from full-time family care............... 33 Additional resources................................................................................. 34 Authors Vicki L. Schmall, Extension gerontology specialist emeritus; Sally Bowman, Extension family development specialist; and Clara Pratt, professor emeritus, Human Development and Family Sciences Department; all of Oregon State University. Acknowledgments Photos by Rod Schmall, West Linn, OR. Caring for a person who is memory impaired is a difficult and stressful job. As a caregiver, you can provide the best care and survive the strains of caregiving when you: ❍ Understand dementia ❍ Attribute behavior problems to the disease and NOT to the person ❍ Communicate effectively with the person who is memory impaired ❍ Manage the environment to lessen problems ❍ Take care of yourself ❍ Seek social support and help This publication provides up-to-date information to guide you in this difficult job. In addition to general care and management guidelines, the publication outlines approaches for self care, handling specific problems— driving, wandering, money management, hiding items, catastrophic reactions, hallucinations, eating, and incontinence—and how to communicate with a memory-impaired person as the disease progresses. HELPING MEMORY-IMPAIRED ELDERS: A GUIDE FOR CAREGIVERS 2 “Senility” versus “dementia” For several years Joe had known he was having memory problems. He compensated by writing himself notes of once-familiar names, telephone numbers, and things he had to do. Sometimes he became annoyed when people tried to oe mistakenly accepted his help by reminding him. He silently problems as the inevitable worried about becoming “senile.” result of aging. He is not He was, after all, 64 years old. J alone. Many people, including Recently, Joe encountered a detour some health professionals, share while driving home from the this myth and label older adults neighborhood grocery store. He who have memory problems arrived home 2 hours late. He had become lost, but he covered up by as senile. Others fear that telling his worried wife aging leads to senility or loss of that he had run into an old friend. memory. Joe’s work suffered. His employer Just getting older does not suggested early retirement. Joe mean losing one’s intellectual felt worthless. Growing old was abilities. Actually, the word senility depressing. has been misused. It is derived from a Latin word that means “to grow old.” Dementia is the appropriate word to describe the significant progressive loss of mental abilities caused by damage to brain cells. The term “neurocognitive disorder,” rather than “dementia,” is the newest term being used by some professionals. Depending on the degree of cognitive decline, a neurocognitive disorder may be further labeled as mild or major. HELPING MEMORY-IMPAIRED ELDERS: A GUIDE FOR CAREGIVERS 3 Dementia is not a specific disease; and it may take more time to learn it is an “umbrella term” describing new information. However, these a range of symptoms associated changes, often called “age-related with impairment in thinking, memory loss,” do not interfere learning, memory, reasoning, with a person’s ability to function and judgment; communication in everyday life. As with muscle and language; and changes in strength, “use it or lose it” is personality, mood, and behavior. equally important for a healthy These changes progress or worsen brain, as is lifestyle, health habits, over time to the point when and physical activity. Activities that a person’s ability to perform challenge the brain, for example everyday activities is severely brain games, may help diminish impaired. Alzheimer’s disease is the these normal declines. most common form of dementia. Many factors can affect Some causes of dementia-like memory. These include stress, symptoms are reversible. depression, fatigue, illness, grief, or Dementia is the result of information overload. Frequently, a disease, not normal aging. people don’t remember something Although dementia is more because they didn’t concentrate in common with advancing age, it is the first place, and the information not a normal part of growing older. wasn’t filed in the brain’s memory Dementia is more common today bank. than it was 100 years ago because Adults concerned about their many more people are surviving to forgetfulness should ask themselves age 85 and beyond. “How did I know I forgot?” The Most people experience some answer: “Because I remembered changes in memory as they grow l a t e r.” In a dementing illness, these older. For example, information memories cannot be recalled processing and recall are slower, because they have not been recorded in the brain or have been 10 Warning signs of dementia: erased. The national Alzheimer’s Association has identified 10 warning signs of Sometimes mental confusion, possible dementia. Early diagnosis is critical for treatment, support, and severe disorientation, and other planning. If you see these signs, get a medical assessment now! cognitive impairments are caused 1. Memory loss that disrupts daily life by treatable conditions, such as reactions to prescribed or over- 2. Challenges in planning or solving problems the-counter medications, alcohol 3. Difficulty completing familiar tasks at home, at work, or at leisure abuse, depression, nutritional 4. Confusion about time (day, year), place (home, store), or person deficiencies, infections—especially (mother, spouse, doctor, names, relationship) a urinary tract infection (UTI)— 5. Trouble understanding visual images and spatial relationships and metabolic disorders such as a thyroid problem. These conditions 6. New problems with words in speaking or writing can cause delirium. Generally, 7. Misplacing things and losing the ability to retrace steps or recall Alzheimer’s disease and other 8. Decreased or poor judgment types of dementia develop slowly 9. Withdrawal from work or social activities over months or years. Any sudden change in a person’s cognition and 10. Changes in typical mood and personality functioning should be assessed For more information, go to www.alz.org or call 800.272.3900. http://www. by a physician. Early medical alz.org/national/documents/checklist_10signs.pdf evaluation is important because HELPING MEMORY-IMPAIRED ELDERS: A GUIDE FOR CAREGIVERS 4 treatable conditions may become common types of dementia are: irreversible if left untreated. Alzheimer’s disease, vascular dementia, motor body dementia, Causes of dementia and frontotemporal dementia. The onset and course of Alzheimer’s disease is the most dementia depend on the nature of common cause of dementia in the the particular disease causing it. United States. The disease destroys Any memory loss that interferes nerve cells throughout the cerebral with a person’s lifestyle, work, cortex, the outer layer of the brain. or daily functioning should Often the first symptoms include be evaluated. Physicians use difficulty remembering recent a variety of diagnostic tools experiences. This is because early to assess whether a memory in the disease the brain loses the problem is significant. Finding ability to record new information, the cause of memory loss is experiences, and events. A person critical to appropriate treatment. will forget a conversation or Symptoms can vary widely, and instructions that were given just 5 no two afflicted persons follow minutes earlier. precisely the same course or rate As Alzheimer’s disease of progression. The four most progresses, affected individuals lose more and more of their memory and other abilities, including the ability to solve problems and complete everyday tasks. Tasks you consider easy to do can be These images depict difficult or impossible for people the progression of with the disease to begin or Alzheimer’s disease from finish. Eventually, they are not the earliest stages (top) able to function independently. to moderate severity (middle) to advanced Increasing cognitive loss leads severity (bottom). To to total disability. Alzheimer’s The image on the left represents a disease is diagnosed by ruling out find out more, visit healthy brain while the image on the all other causes of the symptoms. the website for the right represents a brain with severe Alzheimer’s Association. Alzheimer’s disease. To find out more, As of 2016, there was still no way Illustrations: Alzheimer’s visit the website for the Alzheimer’s to be certain of a diagnosis of Disease Education and Association. Alzheimer’s disease without a brain Referral Center, National biopsy or autopsy. Institute on