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Caregiver Challenges

 REGINA D. Posvar LPN,RNA
REGINA D. Posvar LPN,RNA

Q: I know there is nothing that can be done. I suppose I am past mortified of my mum’s behaviour in public. Sometimes I just cringe when I know she is going to say something horrible to another person. I have been troubled by my brother to not bring her out. She really enjoys getting out of the house. Should I not bring her out?

A: Embarrassing behaviours in public can often be challenging for many families. I noted in this question that you cringe when you know your mum is about to say something not so nice..? This tells me that you fore see it and it is possible to redirect her attention away from behavior that she is about to say or do. If this is the case, there are behavior techniques you can use to redirect her attention to you so you can remove her from the area without causing disturbance.

With that said, I would still bring her out to enjoy life as she always has. I believe the public needs to adapt to changes in life styles and people as this disease grows larger and progresses. We cannot confine everyone to the home. Our communities need to be more Alzheimer’s friendly.

Many family caregivers are often women. And they are managing children, house, work and their own health issues while caring for a family member that can no longer care for themselves. Dressing, bathing and eating often become difficult to manage. Using good strategies to deal with challenging behaviours can be helpful, but keep in mind that each person with dementia experiences the symptoms uniquely and will respond differently and over time as brain changes continue.

Professional caregivers and healthcare providers will also have challenges when working with dementia patients. With all caregivers the behaviour challenges are the biggest struggles.

A few triggers for behaviour changes to be aware of: Medical issues~ pain, UTI, (infection), depression, sleep disorders, lack of exercise/stimulation, change in medications, caregivers not respecting personal preferences. Personal issues~ could be needing to use the bathroom, too hot/cold, bored, tired, frustration at declining ability, and invasion of personal space, feeling unsafe or afraid of the unknown, loss of personal control or choice.

For family and professional caregiving, training and education can be a big help. Education and training can help caregivers recognize signs and symptoms of injury and illness and reduce stress. It will introduce caregivers to resources and equipment that can improve safety.
There has been a general consensus that providers who care for residents with dementia need to be specifically “dementia-trained.” This training should include knowledge of the disease, symptoms, approaches to care, goals of care (cure or comfort), palliative care measures, end of life issues, signs impending death for persons with dementia, and how to interact with residents and families. (Tilly and Fok, 2007)

Q: Dear Ms. Posvar, How can I get Daddy to bathe? He’s just not doing so and says he did. He wears same clothes and I can tell he don’t wash them.

A: It sounds like he is living alone and if not that he is home during the day alone. In this case he may need a little help with initiation of getting in the shower. This can be a challenge as well. But as you are not there, maybe you can sleep over a night, bring a few of your own clothing and ask him if you can wash your clothes as your washer is in the shop. Then say “Daddy let me wash your clothes while I have the washer going” or ask him to wash yours while he puts the wash on.

For bathing there are several factors that cause a person to not want to shower. You will have to be a detective in this area. Some elderly become afraid of water, fear of water coming down on them from the wall (hand-held shower-head is helpful), too cold/too hot or wrong time of day. TIPS~ It is useful to know when the person’s usual time of bathing, if it is bath or shower, have all supplies ready before bathing begins, and make it as pleasant as possible with soothing talk, singing, smells and lots of compliments; always allowing them to do as much on their own as possible; hand them the wash cloth to wash their own face; keep in mind their dignity with modesty (may be reason for repeating “no”). This is a general answer, details are resident specific. Hopefully this can get you started.

Quote~ There is one thing that Alzheimer’s cannot take away. “LOVE” It is a feeling that resides in your Heart and Soul, Love is not a Mem ory
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