Better Care For People With Alzheimers Disease - Long Term Residential Care: Alzheimers

Content provided by the Faculty of the Harvard Medical School

Better care for people with Alzheimer's disease

Residential care facilities with programs for people with dementia have special features that make life easier for them. For instance, many newer facilities are designed to limit noise and have enhanced lighting to help reduce the effects of sundowning. Ample walking space accommodates wandering and diminishes the sense of being locked in. Outdoor courtyards may be designed with natural barriers, such as shrubs, so people with Alzheimer's disease feel as through they have free rein.

To give residents a greater sense of control, there may be cues to help orient them throughout the facility. Hallways may be color-coded, or "memory boxes," showing pictures or other mementos, may be affixed to patients' doors to help them find their rooms.

Many of these facilities strive to keep people with Alzheimer's active and offer a wide array of activities that involve all residents at different levels of ability. The activities should be set up so they provide some meaning and enjoyment to the individual without too much stimulation or pressure to learn. Some examples include participating in arts and crafts projects, going through family photographs, engaging in appropriate exercise, singing, dancing, or listening to music. Even doing chores, such as folding laundry, may be enjoyable for some but meaningless to others.

There has also been a shift in the general philosophy of caring for people with dementia. In the past, the general consensus was that they should be continually oriented to reality. For instance, if a person talked about visiting a sister who had died, the caregiver would remind the person what year it was and that the relative wasn't alive. Experts recommended responses like "No, I'm not your daughter, I'm your nurse."

Experts now believe that these efforts are futile and only frustrate the individual. Today, the preferred approach is to validate the person's feelings. For instance, responses like "You must really love her" to a man who talks about his dead wife, rather than, "She died 10 years ago," fosters emotional well-being. Repeated validation may also curb some behavior problems associated with frustration.

Resurrecting the self

There is also more of an attempt to resurrect what's left of the person's "self." In high-quality programs, caregivers try to understand each person's past interests and plan activities accordingly. If, for example, a person loved to dance, he or she may still derive considerable enjoyment from music and dance activities at a center.

In one case involving someone who had been a newspaper reporter most of his life, his caregivers set up a makeshift newsroom with a typewriter and assigned him the task of writing a newsletter for the center. He was able to enjoy this until typing became too frustrating. Although his caregivers eventually removed the typewriter, they still reinforced the idea that he was working in a newsroom. In another case, a caregiver arranged for several former stamp collectors in the assisted-living facility to see a stamp exhibit that was in town. Despite their disease, the caregiver said they seemed to thoroughly enjoy the experience.

Some art museums around the country have begun offering tours and art therapy programs for people in Alzheimer's care facilities. The hope is that looking at paintings or creating artwork can somehow reach these people emotionally in ways that other experiences no longer can. Some caregivers report that people with Alzheimer's disease become less agitated and more sociable during a museum tour. In addition, some people with Alzheimer's disease display startling abilities to draw, paint, and sculpt, even as they lose their memory and other cognitive functions. Although scientists know very little about the relationship between art and Alzheimer's, the subject was explored at a National Institute on Aging workshop in 2004 on creativity and aging.

Keep in mind that no matter how good the dementia care is in a facility, it will not reverse the tragic course that Alzheimer's disease takes. But these programs report positive changes in residents' social behavior, and health care experts believe that keeping them active can help slow their decline, although this hasn't been proven. Activity certainly helps maintain physical well-being and may help prevent other illnesses and infections.

Last updated:	January 23, 2007