When it comes to Alzheimer’s and other dementias, evidence suggests that a diagnosis of dementia tends to be made relatively late in the disease process. In the past, many physicians would routinely withhold a diagnosis from people with dementia, caregivers or both. Recent research suggests that most people with mild dementia would wish to be told the diagnosis, especially if they are in the early stages of the disease.
Dementia diagnosis provides access to evidence-based treatment, care and support throughout the course of the disease. Earlier diagnosis allows people with dementia to plan ahead while they still have the capacity to make important decisions about their future care. Additionally, their families can receive timely practical information, advice and support.
Only through receiving diagnosis can people with dementia have access to available drug and non-drug therapies that may improve their cognition and enhance their quality of life. They may also have the opportunity to participate in research studies.
Early therapeutic interventions can be effective in improving cognitive function, treating depression, improving caregiver mood and delaying institutionalization. Some of these interventions may be more effective when started earlier in the disease course.
An earlier diagnosis may lead to cost savings as well. Studies have shown that the costs associated with an earlier dementia diagnosis are more than offset by the cost savings from the benefits of anti-dementia drugs and early interventions by the caregiver. These benefits include delayed institutionalization and enhanced quality of life of people with dementia and their caregivers.
What is a geriatric assessment?
If you are concerned that you or a loved one may be experiencing dementia, a geriatric assessment may help. A geriatric assessment is a thorough and comprehensive evaluation of an individual's medical, psychological and social well being. The purpose of a geriatric assessment is to determine and develop recommendations or treatments that will best serve that individual.
An assessment is often performed by a multidisciplinary team of health care professional who work together. The assessment team may include, but is not limited to, physicians, psychiatrists, clinicians and/or social workers. The types of testing done may include blood work, CAT scan, EKG, EEG, MRI, psychological testing or any combination deemed necessary. Once an assessment is completed and evaluated, the physicians and clinicians may refer a patient back to his/her own primary care physician and work with that physician to determine treatment.
A simple question that deserves a thorough response
Losing the ability to drive can feel like a threat to a person's independence. Planning ahead can help ease the transition while providing an opportunity to make choices to ensure safety.
Determining when someone can no longer safely drive requires careful observation by family and caregivers.
The following list provides warning signs that it's time to stop driving:
Forgetting how to locate familiar places
Failing to observe traffic signs
Making slow or poor decisions in traffic
Driving at an inappropriate speed
Becoming angry or confused while driving
Using poor lane control
Making errors at intersections
Confusing the brake and gas pedals
Returning from a routine drive later than usual
Forgetting the destination you are driving to during the trip
Find more help at the Alzheimer's Association Dementia and Driving Resource Center, an ieractive website created with support from the National Highway Traffic Safety Administration. You'll find video scenarios, tips and strategies.
Good health care requires a partnership between the patient, family and physician. Here’s how to get the most out of medical appointments:
Getting ready for your visit Plan ahead Many people report forgetting to ask their doctor all of their questions. Whether you are the patient or the caregiver, avoid this problem by writing down questions and concerns beforehand. Bring the list to your appointment. If you get home and realize you still have questions, call the doctor to discuss them.
Give details Be open and honest when discussing care. Make notes about changes in behaviors, routines or eating habits. Be as specific as you can. When does it happen? How often? Does something seem to trigger it?
Bring medications. People with Alzheimer's or dementia may be under the care of more than one doctor and may be taking medications for multiple health conditions. It is important that everyone on the health care team knows about all prescription and over-the-counter medications, including any vitamins or herbal supplements being taken. Bring medication containers or a complete list (including dosages) with you to each appointment.
At your visit Ask questions. Your doctor is an important source of support and information. If you don't understand something, ask questions until you do. Don't be afraid to speak up and to share your opinion.
Talk about treatment goals. Are medications working? Do dosages need to be changed or monitored? As dementia progresses, the goals of treatment will change. Make sure you understand all treatment options, as well as the risks and benefits of each.
Keep good records. After each appointment, make sure to update your records with any test results or changes to medications or care plans. It's important to keep a personal health record so care can be coordinated between doctors and information is accessible in an emergency. There are many ways to organize and store personal health information, including online services that make it possible to access records from anywhere at any time.
Leave with a plan. At the end of your appointment, ask the doctor to recap the most important points. Write them down. Note any changes to the treatment plan and any follow-up steps needed (such as scheduling the next appointment or having tests done).
Bathing is often the most difficult personal care activity that a
As Alzheimer’s progresses, the person with the disease will begin to need assistance with daily care activities such as bathing. This is most likely to begin in the middle stage and continue into the late stage.
Bathing is often the most difficult personal care activity that caregivers face. It can feel like an invasion of privacy if the relationship between the person with Alzheimer’s disease and the caregiver has not been intimate in this way. Because it is such an intimate experience, people with dementia may perceive providing the care as unpleasant or threatening. In turn, they may act in disruptive ways and can resist by pulling away, hitting or shouting.
Such behavior often occurs because the person doesn’t remember what bathing is for or doesn’t have the patience to endure such unpleasant parts of the task like lack of modesty, being cold or other discomforts. Do not take disruptive behaviors personally. Remaining flexible, patient and calm will serve you best.
Here are some tips to make bathing the person with dementia easier.
Set a regular time for bathing. If the person usually bathes in the morning, it may confuse him or her to bathe at night. Determine what time of day is best for the person with dementia. Then set a routine.
Be gentle. The person's skin may be very sensitive. Avoid scrubbing. Check the spray on the shower head to make sure the water pressure isn't too intense.
Simplify the bathing process. Try different approaches to make bathing easier. For example, sew pockets into washcloths to help the person hold on to the soap, or use soap that washes both hair and body. You may experience the most difficulty when attempting to wash the person's hair. Try using a washcloth to soap and rinse hair in the sink to reduce the amount of water on the person's face.
Coach the person through each step. For example: "Put your feet in the tub." "Sit down." "Here is the soap." "Wash your arm."
Use other cues to remind the person what to do. Try using a "watch me" technique or lead by example. Put your hand over the person's hand, gently guiding the washing actions.
Use a tub bench or bath chair. Having the person sit while showering may be easier and safer. Look for a chair that can be adjusted to different heights.
Be sure to cleanse hard-to-reach areas. Wash between folds of skin and under the breasts. It is important that genital areas are cleansed, especially if incontinence is a problem.
"Sponge bathe" as an alternative. Don't worry about the frequency of bathing. “Sponge baths” with a washcloth can be effective between showers. You may want to try non-rinse soap products, which can be used with warm towels and applied under the guise of providing a “massage."
For more ideas, join ALZConnected, our online support community where caregivers like you share tips on bathing a person with dementia. You can also sign up for our e-newsletter to receive tips on a variety of caregiving topics.
The Cleveland Area Chapter provides a variety of educational programs and classes to give up to date, informative and practical information about Alzheimer’s disease, dementia and memory loss. We have classes designed to serve the general public, health care professionals, individuals with Alzheimer’s disease or other forms of dementia, their family members and friends.
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