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'Avoid stress and frustration' in dealing with dementia patients, doctor tells Harford residents

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Caring for people with Alzheimer's and dementia is no easy task, but neurologist Anne Lipton believes there are plenty of ways to make life a little easier for both patients and caregivers.

"Dementia might not be curable, but it is, generally speaking, treatable in some way," she told about 25 residents and clinicians Friday during a lecture at Bel Air's Brightview Senior Living.

Lipton, who lives in Dallas but studied at Johns Hopkins University, was on tour for her book, "The Common Sense Guide to Dementia for Clinicians and Caregivers."

Alzheimer's, just one of many dementias, is the sixth leading cause of death in the U.S. As the number of Americans older than 65 continues to grow, the Alzheimer's Association expects the number of elderly people with Alzheimer's to nearly triple by 2050, to about 13.8 million patients.

Many residents at the event told deeply personal stories of trying to care for their aging parents. One woman became emotional as she described her mother constantly forgetting that her husband just died.

Other people said their relatives with dementia could be violent or mean. One woman said she felt like she had to look after her mother eight hours a day but also wanted her own space.

Another woman drew a few laughs when she said: "My mother played Scrabble with [her husband] for a long time after he was dead, but she always won. She just turned the board around."

Lipton tried to give them strategies for helping their relatives, urging respect for both the patient and the caregiver. She noted dementia is an umbrella term for a variety of diseases, of which Alzheimer's was just one.

"You want to set your loved one up for success, you don't want to set them up for failure, but you want them to have independence and integrity," Lipton said, explaining that she decided to write the book because many doctors and health care professionals, as well as families, do not know how to deal with patients who had dementia.

Being in new situations, for example, is much harder for them.

"A patient with dementia is going to have a harder time changing and a harder time adapting," she said, encouraging people to see situations from the patient's point of view. "You can understand, if you were in a foreign country and someone was trying to take off your clothes and you didn't understand what they were saying, you would resist that."

New objects pose the same problem.

"I had a lot of families buy those alarm buttons where [patients] weren't able to use them," she said. "Even that one button, they didn't remember what it was for. It was a new thing."

Caregivers should plan ahead more for trips, ask for help and not be afraid to tell people that their relative has dementia.

Lipton also said patients can be offered different activities as long as basics like mealtimes and bedtimes stay the same.

"Just because it's routine, doesn't mean it needs to be boring," she said. "My husband loves to cook and he usually expects a nice dinner, but it's not the same thing every night."

She suggested helping the patient accomplish daily tasks but not trying to "win an argument."

"They may be an accountant who has difficulty figuring out a tip [at a restaurant]," she said of one possible dementia case. In that case, the caregiver could offer to pay half of the bill or pay the tip.

"You can respect the person, you can still let them pay, but you avoid stress and frustration, which are bad for the brain," she said. "If something does go missing… say, 'Let's look together.'"

To Lipton, that means giving patients things that reassure them and taking away those that frustrate or upset them.

For example, patients with more advanced dementia who no longer carry large amounts of money or credit cards may get very anxious if they misplace the wallet, or misplace toothpaste or another household object.

She suggested the caregiver carry a small, duplicate wallet to give them or get travel-size toothpaste bottles to bring out when the patient cannot find one.

When one woman said her mother no longer recognized herself in the mirror because she expected to see a young woman, Lipton suggested getting rid of, or covering up, decorative mirrors. She also suggested distracting the patient and avoiding making them upset.

"You never win an argument with an Alzheimer's patient," Lipton said. "Why subject her to the pain of that [reminder]?"

Another method is giving a non-committal answer to the question of who is in the mirror, like, "That's a very nice lady."

For a patient who shows violent behavior like scratching or slapping, "she is probably trying to reach out to people," Lipton said, suggesting the caregiver give her something to do with her hands like a stress ball or folding clothes.

For patients who are especially hateful or hurtful, Lipton advised telling themselves or others, "That's the dementia talking."

Caregivers also have to know when to draw the line to keep the patient safe. That can include stopping them from driving, which is often "harder for patients to hear than a diagnosis of dementia."

She recalled one man whose family believed he was fine just driving to the supermarket, but when he was asked to draw his route to the grocery store, he drew a map of his childhood home in Ohio. That was when his family realized he should probably not be driving at all.

Lipton urged residents to seek support from professional caregivers when caring for their parents becomes too much or too personal, such as dealing with bathroom hygiene.

If something is not good for the caregiver, it is also not good for the patient, she said.

Respecting the caregiver is just as important as caring for the patient, she said.

Her husband, who worked for Southwest Airlines, told her that "the important thing to their success is not that they put their customers first, but that they put their employees first. If you put employees first, they will take care of your customers."

She also dispelled rumors: when one woman asked whether aluminum could cause Alzheimer's, Lipton said that is not true.

Many people worry whether dementia is hereditary. That is like asking whether heart attacks are hereditary, she said – to some extent, they are, but people can also take plenty of action to prevent them.

"What is good for the heart is good for the brain. If you are worried about getting dementia, do all that stuff that's a lot harder than taking a pill," she said, in reference to exercise, diet and other lifestyle habits.

Misplacing car keys, meanwhile, "doesn't mean you have dementia; it means you weren't paying attention," she said. "People with dementia actually have pretty good attention."

Lipton also made fun of the idea of doing crossword puzzles to keep memory active.

"I don't like doing crosswords," she said. "You have to pick an activity you love. Stress and frustration is not good."

Debra Hanley, community sales director at Brightview, told the audience she hoped Lipton's talk would be helpful.

"Dealing with dementia can be quite a struggle, but it can also be very rewarding and heartwarming," she said.

Copyright © 2014, The Baltimore Sun
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