[Updated 2015 Sep 24]. In: Pagon RA, Adam MP, Ardinger HH, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2015. Caring for a person with Alzheimer’s disease. (Page Last Updated: January 22, 2015). Alzheimer’s Disease Education & Referral (ADEAR) Center – A Service of the National Institute on Aging, National Institutes of Health.
MANAGING THE COMPLICATIONS OF ALZHEIMER’S
Alzheimer’s is an irreversible and progressive brain disorder, but people do not die of Alzheimer’s. It is usually the complications from Alzheimer’s arising over time that can result in serious medical conditions or death. Some of the complications of Alzheimer’s include swallowing difficulty, bladder and bowel issues, immobility, behavioral problems, wandering, mental illness, sleep problems and falls. Difficulty swallowing People with Alzheimer’s may have difficulty swallowing fluids or food towards the late stage of the disease. This might cause them to aspirate food or liquid into the trachea instead of the esophagus, creating blockages in the airways, which can lead to aspiration pneumonia, (the inflammation of lungs). To prevent this, the caregiver should prepare soft foods for easier chewing and swallowing. Fluid intake should also be encouraged, and the caregiver could try thickening liquid with cornstarch or gelatin to decrease the risk of choking. The person should be kept in an upright position for 30 minutes after eating in order to help with better digestion. Bladder and bowel problems People with Alzheimer’s tend to have bladder and bowel problems, such as constipation and difficulties with bladder control. Alzheimer’s patients should be taken to the washroom every few hours to prevent bathroom emergencies and associated falls. The caregiver should be aware of the signs that the person needs to go to the washroom, such as moving around in discomfort, and have a urinal ready beside the bed for an emergency. Absorbent pads may also be necessary for easier clean up. Some people have urinary incontinence at the late stage of Alzheimer’s, so a urinary catheter is often used to drain and collect urine. However, catheters can introduce bacteria and increase the chance of urinary tract infections. Drinking cranberry juice, which protects against urinary tract infections, is recommended when a catheter is required. Immobility In the later stages of Alzheimer’s disease, patients generally lose their ability to function or care for themselves. Affected individuals eventually lose their ability to move their joints, leading to a loss of muscle function and they become bedridden. This immobility means that late-stage Alzheimer’s patients are more vulnerable to infections and a caregiver is required to take care of the patient’s personal hygiene. This includes cleaning the soft tissues of their mouth and brushing their teeth after meals, to decrease the risk of oral bacteria that can lead to infections. The caregiver should also treat all cuts and abrasions, and should try to minimize bedsores by changing the patient’s position every two hours. Bedsores and other abrasions can lead to life-threatening sepsis if not treated. Immobilization also increases the chance of having blood clots in lungs (pulmonary embolism). The caregiver should also try to prevent limb contractures by moving the patient’s arms and legs at least twice daily to maintain the range of motion in joints. Behavioral problems Agitation and aggression are behavioral problems commonly observed in people with Alzheimer’s. They can become anxious or upset easily, or they might scream or act aggressively. Often these behavioral changes are triggered by changes in the surrounding, or physical/mental discomforts resulting from fear, fatigue or confusion. The caregiver should try to cope with the behavioral change by creating a calm environment for the patient. They should also check for physical reasons for discomfort such as hunger, thirst, pain or temperature. It is also important the caregivers to keep their emotions in check, and try not to be confrontational or take the patient’s behavior personally. Wandering Restlessness in people with Alzheimer’s is common, and they might suddenly wander away from home due to confusion or loss of memory. This can be dangerous, as they might fall in the streets or get lost. To prevent this issue, the caregiver could set alarms on the door, make door handles difficult to open and hide the car keys. Alzheimer’s patients should also wear an identification bracelet with emergency phone numbers and address. Mental illness It is common for people with Alzheimer’s to suffer from depression. The caregiver should encourage more regular exercise to help with the stress and encourage the patient to spend more time with people socially or occupy them with activities that they enjoy. Antidepressants might also be useful. Sleep problems People with Alzheimer’s tend to have trouble sleeping through the night and, without a routine, they tend to sleep more in the day and stay awake at night. The caregiver should set a routine schedule for wake up times and bedtimes and discourage naps during the day or at least limit these to a maximum of 30 minutes. Alcohol, caffeine and smoking should be avoided, as these are diuretics that could stimulate urination and disturb the sleep pattern. The caregiver should also check if there are any side effects of medications that could affect sleeping. Falls Loss of muscle and body coordination in people with Alzheimer’s often causes them to lose balance and fall, leading to bone fractures, brain or hip injuries. The caregiver should remove objects that could be easy to trip on and provide non-slip surfaces on the ground. Corridors should be well lit, and night-lights may need to be installed. There should also be handrails for stairs, grab bars for showers, and safety frames for toilets. References: Alzheimer’s Disease Fact Sheet. (Page Last Updated: July 20, 2015). Alzheimer’s Disease Education and Referral (ADEAR) Center – A service of the National Institute on Aging, National Institutes of Health. Bird TD (1998). Alzheimer Disease Overview.dnaserver