Individuals with Alzheimer disease require unique aspects of care that present many challenges. These challenges result from various comorbidities combined with the functional and cognitive decline of the patient. Studies have shown that individuals with dementia and Alzheimer dementia are hospitalized longer than other patients without dementia who have similar health issues.
The Alzheimer’s Association estimates that 6.5 million Americans age 65 and older are living with Alzheimer dementia in 2022. About 1 in 9 individuals (10.7%) age 65 and older has Alzheimer dementia. As the size of the US population, age 65 and older, continues increase, so too will the number of individuals with Alzheimer and other dementias. By 2050, the number is expected to rise to 13 million, so it is inevitable that nurses and staff will be caring for many more patients with Alzheimer across various health care settings.
To support these efforts, we've compiled some various tips to remember when teaching staff about interacting or caring for a patient with Alzheimer dementia.
Communication
- Be mindful that decreased verbal communication doesn’t mean decreased awareness.
- Remember the patient may not be able to recall the names of objects; the use of words starts to decrease as Alzheimer disease progresses.
- Try to limit distracting noises-TV, loud conversation.
- Avoid the use of the in-room intercom to communicate with the patient. This may frighten or confuse the patient by only hearing voices.
- Always approach the patient from the front; state your name and be sure to call the patient by name. Be sure to maintain good eye contact and use short and simple sentences.
- Give the patient ample time to respond to a question (approximately 20 seconds). If necessary, repeat your question the same exact way.
- Avoid testing the patient’s memory. Refrain from asking the patient, “don’t you remember?”
- Assist the patient with wearing of hearing aids, eyeglasses, dentures, etc. These devices help to enhance patient communication.
- Avoid talking about the patient as if the patient is not in the room.
General care for Alzheimer patients
- Assign the same staff to care for the patient as much as possible.
- Avoid room changes. Change increases confusion and anxiety.
- Assess the patient for sources of pain and discomfort. Although pain may be experienced, the patient may not express or complain of pain.
- When providing care or treatments to the patient, let the patient know what you are doing, one step at a time.
- Give directions in a simple manner and one at a time.
- Allow a cushion of “rest” time between stimulating events.
- Provide verbal reminders and physical cues such as lightly touching the forearm when the patient eats at mealtime.
- Give the patient frequent reminders to swallow during mealtime (for the patient in the later stages of Alzheimer disease).
- Ensure any tubes (nasogastric tubes, IVs, indwelling urinary catheters) remain unobtrusive as possible for the patient. There are a number of clever ways to make them less visible and noticeable.
Medications
- Review and eliminate redundant and potentially harmful medications the patient may be taking.
- Use antipsychotics with extreme caution and close monitoring because they carry a significant risk when utilized in this patient population. Research indicates that antipsychotics are associated with an increased risk of stroke and death in older adults with dementia. The FDA has issued a boxed warning on the risk of these drugs and that they are not approved to treat dementia symptoms.
- Avoid the use of anticholinergic drugs. They can be used to treat various medical problems such as sleep disturbances, muscle spasms, incontinence, etc. The side effect of confusion can be serious for individuals with Alzheimer disease.
- Be mindful that there are FDA approved drugs for individuals with dementia. For sleep disturbances, suvorexant, approved for treating insomnia has been demonstrated to be effective in patients with Alzheimer disease. Other medications may be used, off-label, to treat depression, examples include citalopram, and fluoxetine. The use of lorazepam and oxazepam have been useful for treating anxiety, restlessness, and verbally disruptive behavior.