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The Middle Stage: Learning to Cope and to Plan Ahead
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The middle stage of Alzheimer’s disease is the longest and is characterized by worsening mental function and confusion, personal and home safety issues, personal care concerns, and oftentimes, challenging behaviors. The caregiver now needs to learn coping and communication techniques, to arrange on-going help and support and to plan for care as the disease progresses.

  • A simple and supportive daily routine is helpful. A regular and predictable schedule is important, as are activities and exercise. Adult day programs are often useful in providing this type of routine as well as allowing caregivers to have a break.

  • Effective communication skills make a difference.  Everyone interacting with the person with the disease needs to learn how to communicate with them effectively.  As the disease progresses, they lose the ability to organize their thoughts or to remember the meaning or usage of words. Using simple techniques to communicate with them can reduce anxiety, improve self-esteem and decrease problematic behavior.

  • Wandering can become a concern.  They may not recognize familiar surroundings and preventive measures to prohibit wandering and getting lost need to be in place.

  • Home safety is also a concern. The home environment at this point should not contain any safety hazards. Caregivers need to “Alzheimer’s-proof” the home.

  • Sleeping problems are common.  The person with the disease may sleep at odd times of the day and often disrupts the household at night.  Frequently restless at night, they may do repetitive things such as pacing the floor or rummaging through drawers and closets.

  • Resistance to bathing and other aspects of personal grooming are usual.  The need for “hands-on” care arises at this point. Also, the person with dementia may have trouble finding their way to the bathroom or knowing what to do once they get there. Toileting accidents may occur.

  • Problems with balance and an unsteady gait can become a concern. Because of a loss in physical coordination from the disease, persons with dementia may have difficulty with balance and are at risk for falling. Safety accommodations need to be made at home.

  • There may be changes in the appetite of persons with dementia.  The caregiver will need to be more diligent to ensure proper nutrition, particularly if the person has other medical conditions.

  • Personality and behavior changes may occur. These can present the most challenges to caregivers. In approaching these changes, a caregiver needs to be creative, flexible, patient and compassionate. What helps as well is to not take things personally and to maintain a sense of humor. Learn to say to yourself, “So What?’ when you become disgusted or embarrassed by the activities and actions of person with the disease.

Here are things that are helpful to do at this point:

*Establish a predictable daily routine for the person with the disease.

*Arrange for regular help from family, friends, home care agencies or adult day programs. Taking breaks is the key to preventing caregiver burnout.

*Learn about challenging behaviors and ways to manage them.

*Address personal and home safety issues.

*Get support for yourself – from friends, family members, health care professionals and support group participation.

*Start exploring options for long-term care – well before you need it. This will give you the greatest amount of choice in care and setting.

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Alzheimer's Association

Our vision is a world without Alzheimer's
Formed in 1980, the Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's care, support and research.