Alzheimer’s is a deadly disease. In simplest terms, Alzheimer’s is an irreversible, progressive brain disorder that slowly deteriorates memory, thinking skills, and brain functioning. Eventually, this deterioration results in the person’s inability to do even the simplest routine tasks. In most people with the disease—those with the late-onset type—symptoms begin to appear in their mid-60’s. Alzheimer’s disease is thought to be caused by the abnormal build-up of proteins in and around brain cells. Some of these proteins form plaques around brain cells. Others ultimately form tangles within brain cells. These plaque build-ups result in the brain’s loss of neurons and the connections among neurons.

Causes of Alzheimer’s Disease

Scientists do not definitively know what causes Alzheimer’s disease, but it is thought to be caused by an abnormal build-up of proteins in and around brain cells. Alzheimer’s is believed to result from a combination of genetic, environmental, and lifestyle factors. And while old age does not cause the disease, it is currently believed to be a significant risk factor for the disease.

The Seven Stages of Alzheimer’s Disease

Alzheimer’s disease typically progresses in three phases—early, middle, and late. Within these phases, there are thought to be seven (7) stages. These stages are

  1. Before Symptoms Appear
  2. Basic Forgetfulness
  3. Noticeable Memory Difficulties
  4. More Than Memory Loss
  5. Decreased Independence
  6. Severe Symptoms
  7. Lack of Physical Control

Symptoms of Alzheimer’s Disease

Here are some signs of Alzheimer’s disease:

  1. Increased memory loss and confusion.
  2. The inability to learn new things.
  3. Difficulty with language and problems with reading, writing, and working with numbers.
  4. Difficulty organizing thoughts and thinking logically.
  5. Shortened attention span.
  6. Problems coping with new situations.

Caring for Clients with Alzheimer’s

Providing adequate care for clients with Alzheimer’s disease generally depends upon the stage of the condition that they are in:

Early-Stage Caregiving

In the early stages of the disease, your primary role as caregiver is one of providing support and companionship. Clients in the early stage of the disease may need help with (1) keeping appointments, (2) remembering words or names, (3) recalling familiar places or people, (4) managing money, (5) keeping track of medications, (6) planning or organizing, and (7) transportation. In this early stage, it’s best that caregivers focus on the client’s strengths and help them remain as independent as possible, as safely as possible.

Middle-Stage Caregiving

During the middle stages of Alzheimer’s, damage to the brain can make it difficult to express thoughts and perform routine tasks. As a caregiver, you may notice that the client with Alzheimer’s (1) jumbles words, (2) has trouble dressing, (3) gets frustrated or angry more easily than usual, and (4) acts in unexpected ways. As the caregiver, you will be required to demonstrate great flexibility and patience. As your client becomes less independent, you will have to take on greater responsibility for his or her care.

Learn what to expect from the client in the middle stage of the disease so that you can be prepared and respond accordingly. Use a calm voice when responding to repeated questions. Use simple written reminders if the client can still read. It may be helpful for you to create a daily plan of activities and stick to this plan. Certainty and familiarity will help the Alzheimer’s client cope better with the disease.

Late-Stage Caregiving

As Alzheimer’s progresses, the needs of the client become more serious and will deepen. A person with late-stage Alzheimer’s (1) will have difficulty eating and swallowing, (2) will need assistance with walking and may likely become unable to walk at all, (3) will need full-time help with personal care, and (4) may become particularly vulnerable to infections, especially pneumonia.

In the late stage of the disease, the caregiver should be focused on preserving the quality of life and dignity. Although a person in the late stages of Alzheimer’s may lose the ability to talk and express their needs, researchers have established that generally, some core of the person’s self still remains. This means that the caregiver may still be able to connect with the client through the late stage of the disease.

At the late stage of the disease, the world is generally experienced through the senses. A caregiver can express his/her caring through touch, sight, sound, taste, and smell. To accomplish this, you might try to connect with the client by (1) playing his or her favorite music, (2) reading portions of books that have special meaning for the client, (3) looking at old photographs together, (4) preparing a favorite food, (5) rubbing lotion with a favorite scent into the skin, (6) brushing the client’s hair, or (7) sitting outside together on a nice day.

Since care needs are extensive in the late stages of the disease, they may exceed services provided in the home, even with additional assistance. This may mean that the family may have to decide to move their loved one into a facility that can provide intensive Alzheimer’s care. This may prove to be one of the most challenging decisions that a family will ever have to make.

One of the most important daily caregiving tasks provided during late-stage Alzheimer’s is monitoring eating. As a person becomes less and less active, he or she will require less food. But a person in the late stages of Alzheimer’s may forget to eat or lose his or her appetite. To help the person in late-stage Alzheimer’s maintain proper nourishment, allow plenty of time for eating and (2) make sure the person is in a comfortable, upright position when he or she eats, (3) adjust foods if swallowing become a problem, i.e., choose soft foods that can be chewed and swallowed easily, (4) encourage self-feeding, (5) help the person with feeding, if necessary, and (6) make sure he or she receives adequate fluids.

In addition to monitoring eating, caregivers must also pay attention to someone with Alzheimer’s (1) bowel and bladder functions, (2) skin and body health, (3) infections, especially pneumonia, and (4) pain and illness.

The most critical role for a caregiver who has a client with Alzheimer’s is to set and maintain a standard schedule and to maintain a consistent, nurturing environment. The caregiver must also put in the time needed to care for him or herself. Caring for clients with Alzheimer’s is probably one of the most taxing and demanding jobs you will ever take on. Just remember that you can’t provide an adequate level of care for anyone else if you don’t, first, take proper care of yourself. Remember that the loved ones of the Alzheimer’s client need you to provide the level of care they would provide if that were possible. Remember, too, that though it might not seem so, the client inflicted with this deadly disease wants and deserves to live the best life possible for as long as they can. Your job is to do all that you can to see that this occurs.

About the Author

Cynthia Barnes, PhD, lives in Denver, Colorado and is an experienced educational and training professional at all educational levels. Dr. Barnes has a background in organizational development and change and systems thinking/operating. She is a published author with exceptional written, oral, and interpersonal relationship skills. Dr. Barnes has consulted with organizations and school systems throughout the United States and in Canada, Germany, Micronesia, and South Africa.

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