Alzheimer's & Dementia Articles

Article / Updated 08-21-2016

Not every nursing home is a great place. AARP published the following list of warning signs of a bad nursing home. If you encounter one or more of these negative indications, run, don't walk, out of there and definitely do not place your loved one in that facility. Odors: A strong smell of urine and feces indicates a shortage of staff to help residents to the bathroom or to keep residents and the facility clean. Lack of privacy: Residents should not be undressed or partly dressed in rooms or hallways in view of guests and other residents. Staff should knock before entering rooms. Lack of dignity: No resident should be spoken to disrespectfully. Unanswered calls for help: Every call bell or cry for help should be attended to promptly. Loneliness and inactivity: People-watching is fun, but residents shouldn't spend hours on end sitting at the nurses' station, front door, or in front of a TV. Lack of help with eating: Residents who can't feed themselves shouldn't spend mealtime with full trays in front of them. Restraints: Restraints are no longer allowed in nursing homes so you shouldn't see them in use. Vests and other devices that tie or otherwise hold people down in their beds and wheelchairs are dangerous and humiliating. Good nursing homes seek safe and respectful ways to protect residents from falls and wandering.

Article / Updated 08-21-2016

If your loved one isn't yet ready for an assisted living facility or a nursing home but you don't feel that your situation is conducive to providing 24/7 in-home care, adult daycare is for you. Adult daycare for people with dementia and its newer cousin, adult day healthcare, can be a real godsend for a two-career family that simply can't provide in-home care during work hours and doesn't like the idea of leaving their loved one alone at home all day alone or with an aide. Adult daycare provides some real benefits for dementia patients as well, giving them the chance to socialize and participate in enjoyable activities with their peers in a safe and controlled professional environment. Adult daycare evolved from the child daycare model, but it should never be confused with childcare. These programs are geared toward adults, with adult activities tailored to meet the capabilities of the participants and an atmosphere designed for adults. Adult daycare programs are usually open five days a week during traditional business hours. These programs are designed to meet the needs of both functionally and cognitively impaired older adults, though programs can vary depending on the population that they target. In other words, some daycare programs are designed for patients with mild to moderate dementia, whereas others cater to the needs of those with more advanced dementia. Some adult daycare facilities provide transportation. Most programs provide at least lunch meals on the premises as well as some support services such as medication reminders and blood pressure monitoring. In addition to providing respite for the caregiver, these programs provide enjoyable and appropriate social activities and engagement for those with memory disorders. Having AD or dementia doesn't mean you no longer have a need to feel meaningful or socially connected to others. Attendance at an adult day program can provide a sense of purpose and a reason to get up in the morning for your loved one. Dementia and AD patients are often leery of change, so you may encounter some resistance when you first pose the idea to your loved one. Acknowledge that they have some healthy skepticism, and reassure them that you'll preview the program together. If you ask whether they want to go, you're almost certain to get a no. You would be wiser to ask if they would prefer to preview the "wellness center, senior center, or activity center" on Monday or Wednesday, thereby giving them a choice and sense of control but not the final decision about whether to go. Keep in mind that it may not be necessary for your loved one to know that he isn't formally enrolled in the program. You can tell him that he is attending on a volunteer basis. The staff of the day center is probably familiar with this approach and will be willing to acknowledge him as a helper or volunteer rather than a paid subscriber. As a transition, you may want to start off with attendance just twice a week and over time increase the number of day your loved one attends. After you initiate enrollment, try to stick with it for a few weeks before quitting. After your loved one settles in, makes a few friends, and starts participating in the activities, he may begin bugging you to go to daycare even on the weekends. Adult day healthcare programs offer more comprehensive care than regular adult day programs for patients who require specific medical or psychiatric supervision. They provide services, such as on-site nurses, social workers, physical therapists, and other medical and caregiving professionals, in addition to the social activities, meals, and transportation services offered by regular adult daycare. The nice thing about these programs is that they don't use a one-size-fits-all approach. Activities are tailored to your loved one's interests, needs, and abilities. One patient who has mobility problems may do crafts whereas other patients who are more mobile participate in a light exercise class. Another patient may visit with a nurse for a blood pressure check and then join his fellow patients for a snack or musical entertainment. But the most important function adult daycare serves is that it eliminates the problem of social isolation that can overwhelm a person with a memory disorder who stays at home all the time. These places offer so many enjoyable planned activities, from crafts to music to exercise games, that your loved one is sure to find something to enjoy.

Article / Updated 08-21-2016

You can start by checking the bulletin board in your local senior center or community center. People looking for work as aides often post their credentials there. If you can't locate any potential candidates that way, place an ad in the local paper or post a notice at the senior center. If you're a member of a church or synagogue, ask around to see if anyone is interested in the job or has used such a service. Talk to friends or coworkers, ask your doctor's office staff for suggestions, call assisted living or other care facilities to see if someone is seeking part-time work, or call the Alzheimer's Association for information on local agencies. The Family Caregiver Alliance has an excellent webpage entitled Hiring In-Home Help. This guide can help you assess your needs, write a job description, rehearse a sample interview, and determine whether to use an agency or privately hire a home health aide. It also helps you locate resources within your own community that may be able to assist you in your search. Or look at New LifeStyles: The Source for Senior Living for an area guide to senior care options in your area. Their home page can help you find senior care providers and options, just by searching with your zip code. You and your loved one should interview several candidates. If he is able, allow your loved one to ask questions of the candidates and interact with him to assess whether they could be compatible. Also be sure to do the following: Ask for a work history and references, and actually call them, even if the person is someone you know. Discuss salary requirements and pay frequency. Ask whether the candidate has dependable transportation. Ask what services the aide will provide and what hours he or she is available to work. Clearly outline what the aide's responsibilities will be and invite her to ask any questions about the job and about your expectations and requirements. Describe a difficult scenario and ask her how she would handle it. Ask her if she knows what AD or dementia is and what it means to her. This will give you a sense of her knowledge and experience of the disease, as well as her personal perception of those afflicted by it. Ask her why she chose to go into this line of work, particularly her desire to work with patients with memory disorders. Ask her if a free training program for caregivers of patients with memory disorders is available through your local Alzheimer's Association, would she be willing to attend. Ask if she would be willing to read literature about ways to care for patients with dementia or AD. For a different approach to finding a home health aide or companion, eldercare.com maintains a database of aides seeking employment caring for seniors in their homes as well as other senior care options. Tell the aide about your loved one's condition, but don't make the mistake of talking about your loved one as if he wasn't right there in the room with you — this dehumanizes the person with the memory disorder and can make him angry or unhappy! If you need to share things with the aide that may upset your loved one, do so privately. Also tell the potential employee about any special needs your loved one has, such as requiring assistance with toileting, bathing, or dressing, and your routine for doing these tasks. Check with your insurance agent to see whether you need to adjust your home insurance policy to cover an in-home employee. When you do hire someone, make the job offer in writing, specifying hours, duties, and salary. Tell the aide how often you'll pay her and on what days. Make a copy of the aide's Social Security card and driver's license. You'll need the card for tax purposes and the driver's license copy as a security measure. These steps can avoid a lot of confusion later on. If, for whatever reason, the aide you hired doesn't prove to be a satisfactory choice and you find it necessary to replace the aide, give her written notice and a couple of weeks' severance pay to tide the aide over until she can find another job. Although you're not strictly required by law to offer notice and severance pay, doing so is a generous gesture that can go a long way toward smoothing out any difficulties that the firing may bring up. If you pay the aide $1,900 or more during a year, you must deduct Social Security and Medicare taxes from her wages. Once a year, you're required to report the income to the IRS and pay the taxes you've deducted. By law, you must provide your employee with copies B and C of IRS form W-2, outlining her wages and the taxes withheld by January 31 of the year following the year the wages were paid. You have until the last day of February to send Copy A to the Social Security Administration. After you hire someone, make sure you pay the Social Security and Medicare taxes that are due on the wages you pay her, or else Uncle Sam may pay you a visit. Consult your financial adviser or visit the Social Security website for information about the financial responsibilities of people who employ household workers. If you don't pay the taxes on time, you'll have to pay the overdue taxes plus a penalty.

Article / Updated 08-21-2016

Many families feel that they don't have any other choice but to care for their loved ones at home without outside assistance. According to the Alzheimer's Association, 28 percent of caregivers have annual incomes less than $20,000. Financial constraints force them to personally shoulder the burden of providing care for their loved ones. Even families with higher incomes may find themselves caught in that proverbial sandwich between the financial needs of their elderly parents and the financial needs of their college-age children. When money's tight, providing in-home care rather than spending thousands of dollars for care outside the home may be the best choice. In fact, two-thirds of families caring for a dementia or AD patient choose in-home care as their initial care option. The benefits Providing in-home care in your loved one's home or in your own home does have some concrete benefits: You may worry less because you believe you can better keep an eye on your loved one. You have the opportunity to spend more quality time together. Your loved one may feel more independent. You know that your loved one is being well cared for and treated with love and compassion. Other family members may be able to help provide care as needed. You may feel a unique, deep sense of pride and accomplishment in your role as caregiver. If your loved one is your parent, you're giving back by providing reciprocal care for the parent who cared for you as a child. You may discover things about yourself that you may have overlooked had you not become a caregiver. For example, you may find that you're more caring, supportive, nurturing than you knew, or perhaps you find out that you're an effective problem-solver who possesses great organizational skills. You get in touch with your ability to advocate for yourself and your loved one. You may discover that you're resilient. The drawbacks Now for the cons: You may have to invest some money in refitting the house to accommodate your loved one's needs if the disease is severely advanced or if they have a co-existing medical illness. For example, your loved one may need a grab bar in the bathtub and a toilet seat booster. The strain of providing round-the-clock care by yourself and or overseeing paid caregivers can create tremendous physical and psychological stress and lead to health problems for you as the caregiver. Serving as a primary caregiver can negatively impact your marriage and your family relations due to less time available for you spouse and children. Serving as a primary caregiver can adversely affect your career if it takes you away from your work. Creating space for your loved one in your home can lead to crowding for other family members. For example, siblings who previously had their own rooms may have to share a room to allow Grandpa to have his own room, which can lead to other problems. You may have to prepare a special menu to address your loved one's nutritional needs. You may have very little free time for yourself and your family. The additional costs associated with caring for your loved one may impose a financial strain on your family. No matter how diligent you are, your loved one may still wander away or have an accident, which can lead to feelings of guilt for you as the caregiver. Although it may sound like a lot of negatives are associated with providing in-home care, you can do many things to make it a more positive experience for the whole family. Cost issues Common directs costs to care for your loved one at home may include ongoing medical and doctor care, prescription and over-the-counter drugs, incontinence supplies, and any paid help. However, indirect costs include your own time as an unpaid caregiver including time lost from outside work. Here are a few of the specific costs that you'll also have to consider: Mobility and medical equipment: If your loved one's mobility is limited, a wheelchair can be a lifeline for use both inside and outside, thus ensuring that he can still get some fresh air and that friends and relatives can still take him out and about. Check with local medical supply companies because costs can vary throughout the United States. Different types of wheelchairs are available: Some fold up so they fit in the car trunk; others are electric and can be operated by the person. Note: It takes cognitive ability to safely operate an electric wheelchair (just as it does to drive a car), so a wheelchair will no longer be appropriate as dementia progresses. Doorframes can be adjusted to accommodate a wheelchairs and a ramp can be installed to allow easy access to entrance doors, bypassing stairs. Home adaptations: A large number of special aids and home adaptations are available to make life easier for people with increasing cognitive and physical difficulties. Of course, these adaptations come at a cost. A physical or occupational therapist from a local home health agency can assess a person's needs and suggest suitable aids, including A walk-in shower with a seat A shower chair Raised toilet seats (with or without arms) Handrails throughout the house A chair stair lift installed on stairs to facilitate going up and down Bedside commodes Large-faced clocks for better visibility Some funding may be available for these alterations and adaptations through local agencies or organizations. However, more likely you'll need to purchase them privately. Call your local Area Office on Aging or Alzheimer's Association.

Article / Updated 08-21-2016

Your loved one won't require as much care in the early stages of dementia or AD as he or she will in the later stages. For someone with very mild memory loss, perhaps all you'll need is someone to ensure that medications are taken as prescribed. The care plan you start out with will change and become more comprehensive as your love one's condition progresses. The following tables present the various care options that are available for patients. Respite Care Choices for Patients Respite Care Choice Care Provider Location Cost Informal unpaid care You or another family member, friend, or neighbor. Your home or your loved one's home. No out-of-pocket cost other than medical bills, but you may have to adjust your work hours, take FMLA, or give up your job to provide care, depending on your loved one's level of need. Paid caregiver or companion service You may contract with an individual or hire a paid caregiver from an agency. Your home or your loved one's home or elsewhere depending on need (for example, acute illness requiring hospital stay — hire a sitter to stay with patient overnight in the hospital). Average about $20/hour, but range is $15-25 per hour. More to hire from an agency. Home healthcare aide for patient with co-existing medical needs Home health aide, LVN, RN licensed to provide medical services. Same as paid caregiver. $25 to $50 per hour, depending on certification and need. May be covered by Medicare for limited time for skilled needs. Adult daycare Paid staff and volunteers. Free-standing center for adults with dementia or affiliated with a hospital, church, or care facility. Average cost in 2015 is $69 per day with different state averages ranging from $35 to $124 per day. May include transportation; services such as bathing cost extra. Day healthcare for patients with dementia and co-existing medical illness that requires nursing services Paid staff. Free-standing facility or hospital-based. Average $85 to $90 per day; services such as bathing cost extra. Residential Care Choices for Patients Residential Care Choice Care Provider Location Cost Assisted living Paid staff. Assisted-living center. Wide variation, $2,500 to $6,000 monthly average. May have additional costs based on personal care needs. Licensed residential care home (also called a personal care home) On-site nonmedical staff. Neighborhood home licensed to provide care for a certain number of people on site. $850 to $4,000 per month, depending upon location and client need. Dedicated Alzheimer's care center or memory support unit On-site medical and nonmedical staff, visiting medical staff. Alzheimer's care center; may be free-standing or be part of a continuing care retirement community that offers all levels of care from independent living to assisted living to AD care; some also have skilled nursing on site. Assisted living setting can range from $4,000 to $7,500. Nursing home On-site medical and nonmedical staff, visiting medical staff. Nursing home. Shared room $220 daily average. Depends on level of care at nursing home. Monthly can range from $4,200 to $11,000. A common misconception exists that after someone reaches the age of 65, Medicare will pay for all that person's medical needs, including long-term care. Unfortunately, that's simply not true.

Article / Updated 08-21-2016

Talking about end-of-life care options may seem a bit disheartening, especially because the end may still be many years away. But now, as soon as possible after diagnosis, is the time to discuss your loved one's wishes for her end-of-life care. You're going to have to make more decisions than you might think, so you want to start early. If a patient is in the early stages of a memory disorder, she should be asked her wishes and make her own decisions (as much as she is able). Her caregivers should then carry out her wishes. Depending on the severity of your loved one's dementia at the time of diagnosis, she may still be capable of participating in the decision-making process in a meaningful way. You can consult an attorney to have any necessary documents drawn up for signature, if your loved one is still mentally competent to sign. To make sure that the patient's choices for end-of-life care are carried out according to her wishes, advance directives are necessary documents. When a patient hasn't prepared an advance directive and is no longer capable of making such choices, the family caregiver must make these decisions for the patient. Many patients succumb to physical ailments other than dementia or Alzheimer's disease (AD), such as heart attack, stroke, or complications of diabetes. In fact, most people with a memory disorder don't die from the dementia but rather from a complication of the disease, such as aspiration pneumonia or urinary tract infections. No matter how excellent their care has been, as their disease progresses, dementia and AD patients are unable to make decisions for themselves. That's why you should discuss these issues as much as possible while your loved one can still make her wishes known. When your loved one is in advanced stages of dementia or AD, she may experience a life-threatening medical crisis, such as pneumonia, and you must decide what sort of care will be provided. In this sort of situation, you have three major choices available: letting nature take its course, palliative care, or aggressive care. Letting nature take its course When you've lived with a patient with a memory disorder for many years, as you near the end of the road, you may decide that you'll ride out whatever happens and let nature prevail. If you choose this course (based on your knowledge of your loved one's wishes), you absolutely must make these wishes known to your healthcare provider by signing a DNR (Do Not Resuscitate) order. All this order means is that when your loved one is dying, the medical care facility and its staff will allow that natural process to proceed without interfering. Only doctors can complete DNR forms, but only competent patients or their power of attorney (POA) can request them. If you do ask for a DNR, the doctor will sign and ask the patient (if she is capable) or whoever is legally empowered to represent the patient to sign the document as well. Different states have different options for DNR orders, so ask your doctor what these are where you live. The DNR, which is a binding, legal document, is then put into the patient's medical record so anyone who provides care knows what to do if the patient experiences a life-threatening crisis. However, realize that this DNR form usually will need to be re-created each time your loved one is admitted to a hospital or nursing home. Maybe your loved one signed an advance directive called a living will while she was still mentally capable of making end-of-life decisions. Living wills specify the exact types of medical treatment and interventions that patients do and don't want performed if they're in a crisis situation. You may be thinking, "Well, of course if a dementia or AD patient is dying, doctors are just going to let them go." That's not always the case, though. Even when a patient's quality of life isn't good, some healthcare providers are determined to prolong her life no matter what. They may aggressively resuscitate a dying patient, inserting ventilator tubes and performing other invasive procedures to restore life. But if your loved one has had the foresight to sign a living will and you have made sure there is a DNR, then the attending doctors and the medical facility must honor that request. Palliative care Palliative care means that your loved one will be fed and kept comfortable and free from pain. It also means that appropriate care and medications will be given to alleviate any distressing symptoms the patient may display. For example, if a patient is running a fever and is uncomfortable, the doctor may administer acetaminophen to bring down the fever. But no aggressive or invasive measures will be taken to artificially extend the patient's life. The verb palliate derives from the Latin, palliatus, which means "to conceal." Palliative care does just that; it "conceals" the intensity of an illness through moderation of its effects with appropriate care and medications. However, it doesn't change the course of the illness. It is a way of letting nature take its course but at the same time treating pain and other distressing symptoms. Palliative care often goes hand in hand with a DNR order. It's a way for family members to let healthcare providers know that they want to ensure their loved one's comfort and safety without taking any extraordinary or aggressive steps to save that person's life if she experiences a potentially fatal health crisis. This helps prevent unwanted medical intervention at the end of life. One way to provide palliative care is to enroll the person with dementia or AD in hospice. Unless your loved one has another terminal condition (like advanced cancer or heart failure), in order to qualify for hospice using dementia or AD as the terminal diagnosis, certain requirements must be met. The patient with dementia of AD must be at Stage 7c on the Functional Assessment or FAST SCALE. This stage requires that your loved one is unable to walk without significant assistance and the ability to speak is essentially gone. In addition, she must have had at least one of the following conditions in the last 12 months: Aspiration pneumonia Kidney infection Multiple severe bedsores Recurrent fever Weight loss of at least 10 percent of body weight Medicare pays for hospice and requires your loved one's physician to certify that life expectancy is six months or less. To stay on hospice during that time, the patient must continue to show decline. Hospice can be provided at home if a caregiver is present 24/7 to care for and monitor the patient and provide medications for comfort as needed. It can also be provided in an assisted living facility or nursing home. Some larger cities have an inpatient hospice center where patients can be admitted. Aggressive care Some families just can't accept the idea of letting go of a beloved family member, no matter how far advanced her illness. These families may choose to opt for aggressive end-of-life care, authorizing their physicians to employ whatever means necessary to prolong their loved one's life, including the use of ventilation equipment to maintain breathing and oxygenation and defibrillators to restart the heart. Although end-of-life care is an extremely personal choice, choose carefully if you're considering an aggressive approach. Aggressive care is appropriate and understandable in situations where someone has suffered a traumatic injury or is in a critical stage of an illness that could be treated. If these patients can be helped through their crises, they may recover fully and go on to enjoy many more years of a good quality of life. Other times, it can be the beginning of a long road on life support, promoting quantity of life over quality of life. You need to remember your loved one's dementia or AD is a progressive disabling condition. Even if you "save" your loved one, ask yourself: "What am I saving her for?" You have to determine to what degree your loved one has quality of life. You and your loved one have already been through a lot simply dealing with a memory disorder. If there is no quality of life, there's absolutely nothing wrong with choosing to let life end naturally.

Article / Updated 08-21-2016

Many advances in scientists' understanding of Alzheimer's disease (AD) and its effects upon the brain have come from the study of brains donated by the families of deceased Alzheimer's patients. In addition, some families find closure when they choose to donate their loved one's brain, because a post-mortem brain autopsy is still the only way to confirm a diagnosis of AD with absolute certainty. Brain autopsy may involve cost, and special arrangements must be made prior to your loved one's death. If you decide to donate your loved one's brain after her death, you need to start the process now. Through brain donation, you help researchers as they look for answers to prevent dementia and AD as well as define future treatments. However, because brain tissue is only viable for 24 hours after a person dies, arrangements must be made well in advance of your loved one's death. Contact a research center, brain bank, or university to make brain donations arrangements. For more information on brain donation, contact your local Alzheimer's Association or check these websites: ALZFORUM Alzheimer's Disease Center

Article / Updated 08-21-2016

In the United States, most people older than 65 have access to the Medicare program. In other parts of the world, people with dementia who can't afford to pay for their healthcare can become unnecessarily disabled as a result. Making good and sensible use of what is available is thus important. People with a memory disorder obviously need help specifically for whatever disease is producing their symptoms. But they may also have other medical conditions such as heart disease, diabetes, high blood pressure, asthma, thyroid disease, or arthritis that also need treatment and monitoring. The following discussion points out how you can help your loved one with all types of healthcare issues. People with chronic diseases such as diabetes, high blood pressure, and heart disease should regularly be seen by their physician. Keeping these appointments is vital. Visiting doctors, dentists, podiatrists, and opticians Looking after the person's teeth, feet, and eyes is important. Make sure they're checked at least annually, if not every six months. Prevention is always better than cure. Bear in mind that people with dementia and AD may feel anxious about visiting the dentist or being in an unknown, potentially busy, environment. Behavioral problems and agitation may result. Try to keep stress levels to a minimum by Attending appointments with your loved one to offer support and give him confidence Trying to attend the same clinics and see the same clinicians each time so your loved one gets used to the surroundings and personnel Letting the professional know that the person you are with has dementia, and giving him useful tips for minimizing the potential stress of the situation for all concerned Taking along a written list of points you want to cover with the clinician, including any concerns voiced by your loved one Allowing the person with dementia to talk for himself if he is able and not irritating him by talking over him Not covering too much in one visit and making the experience exhausting Don't let a previously stressful visit or the person's declining dementia keep you from taking him to appointments again. His physical health is vital to him. Coping with pills and medicines Prescription medicines often have ridiculous names that make them hard to pronounce and remember, even for caregivers, let alone people with a memory disorder. Pills for different conditions can also have extremely similar names, which can lead to confusion. Penicillin, for example, has a very close namesake — penicillamine — that's no help at all in treating infections because it's designed to modify the symptoms of rheumatoid arthritis. And if that's not enough, drugs often go by both their generic and brand names. A common capsule to treat the symptoms of reflux and heartburn is known by its brand name, Prilosec, and its generic name, omeprazole. For all these reasons, mixing up pills is very easily done. A person on multiple drugs for lots of different conditions could be made very ill as a result of confusing different medicines. Mixing up medications also involves the risk of under- or overdosing. Checking what's what with the doctor The person's primary care physician's nursing staff should be happy to sit down and take you through each medicine the person you're caring for is taking and what it's treating. Try to arrange such a meeting as early as possible when you begin caregiving so you have a clear understanding of what's going on. You can then explain the pills to the person you're caring for, and repeat as necessary each time he asks. Knowing the purpose of each medication also means you can stress the importance of taking each one and when it should be taken. Using pill boxes and blister packs Some pharmacies dispense the person's medication in a blister pack for a charge. This involves grouping together pills in a packet to be taken at a particular time of day for each day of the week. Automatic pill dispensers provide another way to ensure medication is taken safely. These dispensers give access only to the pills needed at that time of day and have the added advantage of an alarm to remind the person when to take his tablets. They may even be able to close after a period of time even if the person hasn't taken the pills to avoid them from being taken to close to the next dose. And having the pills safely locked in the automatic dispenser until the allotted time minimizes the chances of overdose. You can buy these dispensers online. They have to be filled by family or caregivers. The most common method of tracking medication use is to set them out in weekly pillboxes where the pills for each day are put in that day's slot identified as S/M/T/W/TH/F/S. As caregiver, you have to fill these pillboxes appropriately (with the help of your loved one if he is capable). Then you can leave out only that week's pills and make sure your loved one takes only the appropriate daily dose.

Article / Updated 08-21-2016

Patients with memory disorders such as dementia and Alzheimer's disease (AD) function best in a calm and well-structured environment. That means eliminating potential sources of trouble as much as you can. According to the National Center for Injury Prevention, falls are the leading cause of injury deaths in adults aged 65 and older. One in every three older adults falls at least once each year. One out of every five falls causes a serious injury such as a broken bone or head injury. Every 13 seconds, an older adult is treated in the emergency room for a fall; every 20 minutes, an older adult dies from a fall. Among people aged 65 to 69, one out of every 200 falls results in a hip fracture; that increases to 1 out of every 10 falls for those age 85 and older. In 2013, the total cost of fall injuries in the United States was $34 billion and is expected to increase to $67 billion by 2020. For a dementia patient, that half-inch step into the kitchen could be disastrous, leading to a serious fall and maybe even hospitalization. To help you patient proof your home, download a free copy of this document or read it online. Patient proofing your home In addition to locking up knives and other sharp objects in the kitchen, you should lock up matches and lighters. You should also put a kill switch on your stove or remove the knobs so your loved one can't accidentally start a fire. Put childproof latches on all your cabinets, and if you have any throw or area rugs in the kitchen, remove them. Remove any electrical wires that run across open spaces to prevent tripping, and put childproof plugs in all your electrical outlets. Walk around your house and look at each room with a critical eye. If you see something that looks like it could cause a problem for your loved one, remove it or secure it so it no longer presents a hazard. Then you can rest assured that you have done your best to patient proof your home. Even with all reasonable precautions taken, accidents can still happen. Don't blame yourself. Seek treatment for whatever injuries your loved one may have and move forward. Here are some more specific tips: If your loved one wanders, you need to secure the entire house and yard to keep him from getting lost. Install locks on top of entrance doors to keep your loved one from getting outside unsupervised. Install locks on windows and use childproof doorknobs to make it more difficult for him to escape. Put locks on your garden gates, and if your yard isn't fenced, consider putting in a high fence as soon as possible so you can keep your loved one secure at home while allowing him to engage in normal, healthy outdoor activity. But remember, no fence is tall enough and no gate is secure enough to substitute for your supervision! Disengage the garage door opener. Install alarms at the exits to let you know if someone is trying to get out. You also can use alarm mats that sound if someone steps on them. If you can't afford alarms, hang a bell on the door to alert you if someone is leaving (although this may not be enough to wake you from a sound sleep). Let your neighbors know about your loved one's condition so they can alert you if he manages to sneak out despite all your precautions. You may even want to take your loved one on a nice walk around the neighborhood to introduce him to your neighbors, but remember, discuss your concerns with neighbors, either before or after this visit. As you might imagine, patients don't like to be discussed as if they weren't standing right there. If you have a flight of stairs in your home, you must put gates at both the top and the bottom to keep your loved one from trying to go up and down unassisted. Mark the first step, top and bottom, with a wide, brightly colored tape so they'll be aware of where it is. Make sure a handrail is securely fastened to the wall on both sides of the stairs and will support the weight of a falling person. If the handrails are flimsy, have them replaced. Use technology to help. Cameras, coined as Grannie-cams, can allow monitoring over the Internet, and baby monitors can provide audio monitoring from another room in the house. Alert-button necklaces or bracelets also allow someone to push for help in the event of a fall or other emergency. Realize that such alert buttons require the wearer to understand and remember to push the button when needed for them to be effective, which may be impossible for a dementia or AD patient. Install smoke alarms and don't use portable space heaters because they're a huge fire risk. Cover the fireplace and put cushioned corner bumpers on sharp edges of furniture to prevent injury in case of a fall. Keeping track of an Alzheimer's patient No one knows exactly why Alzheimer's patients wander, but the reality is that a certain number of them do. If your loved one wanders, it probably scares you to death. To help make sure the wandering isn't a tragic experience, a number of programs are available to help find your loved one and return him home. Use iron-on labels with your loved one's name, address, and phone number imprinted on all his clothing, even his socks. This could make a big difference between a speedy return or a lot of red tape if your loved one gets lost. The Alzheimer's Association and MedicAlert Foundation sponsor a program called Safe Return. For a registration fee of $55, you receive an ID bracelet or necklace with the organization's 24-hour toll-free emergency crisis line. In addition, when you report your loved one missing, Safe Return sends his picture and information to local law enforcement agencies. If someone finds your loved one, she calls the number and you can be reunited. Finally, membership in the program provides important medical information that doctors or paramedics might need in the event of an emergency. Call 800-432-5378 for complete information. Getting clutter out of the way Something you may live with every day and not pay too much attention to is clutter, but clutter can be dangerous for your loved one. You may love your stacks of magazines and newspapers and laugh when you open a cabinet and 20 plastic containers come tumbling down. But what seems cozy to you may present a real danger for your loved one. In his weakened condition with diminished ambulatory skills and impaired balance, it may be almost impossible for him to navigate around your treasures. If you just can't bear to part with all your treasures or simply don't have time to deal with cleanup at the moment, gather your stuff in boxes and cart it to a mini storage. But be careful about reorganizing your loved one's familiar environment too quickly and too drastically. Familiar spaces and old routines are the dementia patient's friend; changing too much too quickly can trigger undesirable behavior or cause anxiety or paranoia. These clutter tips are for you, not for your loved one. Considering remodeling When you walk through and assess your house, you may come to the conclusion that certain areas simply aren't going to work, no matter how much reorganizing you do. At that point, you may consider remodeling part of the house to accommodate your loved one's needs. Talk to local contractors. It may be more economical to build a small addition with a bedroom and accessible bath than to tear out an existing bath and walls to remodel. Whether you remodel depends on your financial situation and your loved one's needs. Perhaps by combining two households, you can find the capital to make the needed structural changes in your own home.

Article / Updated 08-21-2016

You're about to enter a new world. The parent or spouse or sibling you've known all your life has been diagnosed with dementia or Alzheimer's disease (AD) and is changing before your eyes — perhaps even changing into someone you don't understand or feel as close to as you would like. Remember that your loved one has no more control over these changes than you do over the rising and setting of the sun. If you keep that in mind as you interact with him, you may find it easier to be truly compassionate, patient, and caring in your treatment of him. Simply maintaining a calm and upbeat approach can help keep a patient with a memory disorder content and happy and, therefore, easier to manage. If you're having trouble handling your loved one or find yourself becoming frustrated by his behavior, consider that your response may be triggering some undesirable behaviors or making the behavior worse. If you feel overwhelmed and out of control, you may not be getting the breaks you need. Remember to schedule regular respite care so you have time for yourself. In addition, it may help to give yourself some visual cues. For example, get a large marker and some index cards and write one of the following words on each card: patience, tolerance, compassion, love, acceptance, gratitude, flexibility, and any other keyword you think may help you remember your mission — which is to provide the best possible care for your loved one. Now tape the cards in prominent places around your house where they can remind you of your daily caregiving goals and keep you focused on the task at hand and away from negative thinking. Even with the best possible care, your loved one's condition will progress and his symptoms and problem behaviors will increase. This isn't a reflection of anything you have or haven't done. Blaming yourself and feeling like you're a failure as a caregiver can create more problems. Seek help immediately if you start to experience these negative feelings. All the things you take for granted in the course of your day — taking care of your personal needs like bathing, going to the bathroom, preparing and eating a meal, doing a load of laundry — can become monumental challenges for a dementia patient as the disease progresses. Devise ways to help your loved one take care of his needs without demeaning him or triggering conflicts between the two of you. You'll need an extra dose of patience as your loved one's skills erode. Try to focus on the positive; as long as you're caring for him and trying to help him with the activities of daily living, you have an opportunity to continue your relationship with your loved one, even if it's very different from the relationship you had in the past. Remember . . . patience.