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KISS: A Caregiver’s Guide to the 3 Basic Strategies for Alzheimer’s Management

I recently learned an expression that I say to myself all the time, even though it’s a bit disparaging in nature…

KISS: Keep It Simple, Stupid

 

There are new frameworks and theories for managing Alzheimer’s behaviors being published all the time.  This is wonderful news for healthcare professionals who have had little research to guide them in the past.  However, there is limited access to these new concepts for the informal caregiver who is usually left to “wing it” on a daily basis.  I’ll let you in on a little secret.  It all boils down to making things simpler for the diseased brain that can no longer handle complex functions.  Yes, all the research yields the same conclusion:  Keep It Simple, Stupid.

There are different levels of expertise in the management of Alzheimer’s disease- from pharmaceuticals to architecture.  But for day-to-day operations in the home where someone with Alzheimer’s is being cared for, here are the three basics that most healthcare professions use as a guide*:

1.  Keep communication simple

Don’t be fooled.  Just because someone with dementia can talk a good story, don’t be mislead into believing that everything you say is correctly understood.  And sometimes the more you try to explain, adding layers of meaning and concepts that require interpretation, the more confusing the entire message can become.  Communication issues can be the cause of many battles, resulting from frustration as both parties are feeling grossly misunderstood.  Try to stick to these simple principles:

  • Only give a one step command at a time.  Hold your breath while the first step is completed, and then instruct the next step. Demonstration goes a long way in reinforcing the action.
  • Do not try to replace their reality with your own.  Do not argue just to be right.  Remember that the centers for reasoning and judgment are being clogged by plaques and tangles.  It is a disease, not an argument.
  • Repeat along with me:  Validate, then redirect.  Validate, then redirect.  Validate, then redirect.  “I am so sorry that your money is missing. Let’s talk about it over lunch.”
  • Just be positive and affirming- even when you don’t feel like it.  If their stress is lower, yours will be too.
2.  Make the environment simple and safe
The physical environment plays a huge role in dementia behaviors.  The effect of noise, lighting, clutter, and temperature can cause stress and lead to difficult behaviors.  The strategy is simple:
  • Remove clutter
  • Keep pathways clear
  • Discourage access to the unsafe- sharp objects, exits, stairs, ovens/stoves, matches, medicines…
  • Provide a “go-to” place for reminiscing, rummaging, snacking…
  • Keep rooms well lit, use night lights, comfortable temperature
  • install grab bars
3.   Make the task simple
Consistent routines go a long way in ensuring that basic tasks are accomplished in a reasonable length of time.  Habits replace thinking, and because the thinking process is impaired and slower, habits speed things up.  Here are some other tips:
  • Break down the task into smaller bits.  if the entire process of putting on an entire outfit leads to stress, let them just do one part of it, or simplify the outfit into few pieces.
  • Set out clothes, toothbrushing items, or meals ahead of time
  • Label drawers and cabinets, or use pictures- but don’t rely on this as a form of communication to be consistently followed.  it’s meant to establish routines and habits, so repeat, repeat, repeat
  • Expect processes, even simplified ones, to take longer.  set aside time and allow for the slower pace
* References: Gitlin, Ln N., (2010) A biobehavioral home-based intervention adn the well-being of paitents with dementia and their caregivers.  Journal of the American Medical Association, 304, 983-991
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