Purpose

• Alzheimer’s disease (AD) is a brain disease. Many nerve cells that control intellectual and social function are damaged and die. These functions include memory, thinking, reasoning, judgment, language, behavior, mood, and personality.
• The person has problems with work, everyday functions, and family and social relationships. There is a slow, steady decline in memory and mental function.
• The classic sign of AD is gradual loss of short-term memory. Signs and symptoms become more severe as the disease progresses. The disease ends in death.
• AD is often described in terms of three stages—mild, moderate, and severe. The Alzheimer’s Association describes seven stages:
  • Stage 1—No impairment
  • Stage 2—Very mild cognitive decline
  • Stage 3—Mild cognitive decline
  • Stage 4—Moderate cognitive decline (mild or early stage)
  • Stage 5—Moderately severe cognitive decline (moderate or mid-stage)
  • Stage 6—Severe cognitive decline (moderately severe or mid-stage)
  • Stage 7—Very severe cognitive decline (severe or late stage)
• AD changes how a person behaves or acts. These changes are common:
  • Getting upset, worried, or angry more easily
  • Acting depressed
  • Losing interest in things
  • Believing other people are hiding things
  • Pacing a lot of the time
  • Wandering
  • Sundowning (increased signs and symptoms of AD during hours of darkness)
  • Hallucinations (seeing, hearing, smelling, or feeling something that is not real)
  • Delusions (false beliefs)
  • Paranoia (delusions or suspicions about a person or situation)
  • Catastrophic reactions (extreme responses to minor issues)
  • Agitation and restlessness
  • Aggression and combativeness
  • Problems with intimacy and sexuality
  • Repetitive behaviors (actions repeated over and over)
  • Communication problems
  • Screaming
  • Rummaging and hiding things
• Usually, the person is cared for at home until symptoms are severe. Adult day care may help. Often assisted living or nursing center care is required.

Equipment

Roll cursor over items to see labels. For the purposes of clearly depicting the equipment, a barrier is not shown in this photo. When providing care, a barrier should always be placed on the surface before placing the equipment.

Bathroom picture sign

Dining room picture sign

Outlet plug

Outlet safety plate

Sliding lock at top of door

Medicine bottles with childproof caps

Safety covers for knobs on stoves

Identification bracelet

Easy to put on clothing options

Large calendar

Clock with large numbers

Plastic cup with lid

Plastic eating utensils

Eyeglasses

Hearing aids

Standard nightlight

Sensor nightlight

Radio/CD player

Delegation

• Follow delegation guidelines. Before caring for the person with AD and other dementias, obtain this information from the nurse and care plan:
  • How much assistance the person needs with safety, hygiene, nutrition and fluids, elimination, activity, comfort, and sleep
  • Specific types of care noted in the care plan
  • What observations to report and record
  • When to report observations
  • What patient or resident concerns to report at once

Preparation

• Observe quality-of-life measures.
• Review the information under Delegation and Safety and Comfort.
• Practice hand hygiene.
• Collect the equipment.
• Identify the person. Check the ID bracelet against the assignment sheet. Calling the person by name is not the best practice for identification. A person with confusion or dementia may answer to any name called.
• Adjust the environment appropriately.
  • Follow set routines.
  • Avoid changing rooms or roommates.
  • Place picture signs by room doors, bathrooms, dining rooms, and other areas.
  • Keep personal items where the person can see them.
  • Stay within the person’s sight to the extent possible.
  • Place memory aids (large clocks and calendars) where the person can see them.
  • Keep noise levels low.
  • Play music and show movies from the person’s past.
  • Select tasks and activities that fit the person’s abilities and interests.

Safety

• Some behaviors and problems are not caused by AD. They may be caused by an illness, injury, or drug. If the cause is not treated, it may threaten the person’s life. Always report behavior changes to the nurse.
• Because judgment is poor, persons with AD cannot tell what is safe or dangerous. Life-threatening accidents are great risks. They can walk into traffic or a nearby river. If not properly dressed, heat or cold exposure is a risk.
• The person’s behaviors may not mean paranoia. Fears of harm, strangers, stealing, mistreatment, and so on may be real. Some people take advantage of vulnerable adults. This includes sexual abuse and financial abuse. You must protect the person from harm, abuse, and mistreatment.
• Reassure the person that you are there to help.
• Remove harmful, sharp, and breakable items from the area.
• Provide plastic eating and drinking utensils.
• Place safety plugs in electrical outlets. Or cover outlets with safety plates.
• Keep cords and electrical items out of reach. Or unplug them when not in use.
• Remove electric appliances, such as hair dryers, from the bathroom.
• Store personal care items, such as shampoo and lotion, in a safe place.
• Keep childproof caps on drug containers and household cleaners.
• Store household cleaners and drugs in locked storage areas.
• Store dangerous equipment and tools in a safe place.
• Remove knobs from stoves or place safety covers on the knobs.
• Remove dangerous appliances, power tools, and firearms from the home.
• Store car keys in a safe place.
• Supervise the person who smokes. Store cigarettes, matches, and other smoking materials in a safe place.
• Practice safety measures to prevent falls, fires, burns, and poisoning.
• Lock all doors to kitchens, utility rooms, and housekeeping closets.

Comfort

• Follow the person’s routine. Meals, bathing, exercise, TV, bedtime, and other activities have a schedule. This promotes a sense of order and what to expect.
• Consult the nurse before making any changes to the environment. Such changes can cause confusion for the person with dementia.

Follow-up Care

• Provide for comfort.
• Place the call light within reach.
• Raise or lower bed rails. Follow the care plan.
• Complete a safety check of the room.
• Practice hand hygiene.

Reporting/Recording

• Report and record your observations, including:
  • Signs and symptoms of health problems, such as illness, infection, drugs, lack of sleep, pain, fever, skin alterations, constipation, hunger, thirst, poor vision or hearing, alcohol, and caffeine.
  • Any other changes in the person’s condition.