The Causes of Depression

• Depression may be caused from finding out the diagnosis of Alzheimer's disease. This would be devastating to anyone.
• Knowing that one is losing physical and mental abilities could cause depression as well as anxiety.
• If the patient has to move out of his or her home and give up their possessions because of declining mental abilities, this could set off depression.
• A change in surroundings.
• Not feeling useful or productive.
• Changes in brain chemistry.
• Some medications may cause depression.

What can YOU do?

• In the early stages of the disease, support groups, education about the disease, and even therapy can help the victim deal with his or her diagnosis.
• The carer also needs to keep reassuring the patient in the early stages that they can still have some control over their lives by participating in decisions made for their future.
• Medication may help the person suffering from depression brought on by Alzheimer's.
• Make sure the victim knows you are always there to listen if he or she wants to talk about their feelings.
• Avoid giving them false hope. It's better to face reality in the situation.
• Encourage exercise and social interactions. If the patient feels uncomfortable being with crowds, though, don't force them to participate. You may choose to have friends and relatives visit on a one-to-one basis.
• Discourage the use of alcohol, which may make the patient feel "better" for a while. After the euphoria wears off, it can trigger feelings of depression.

These are just a few things you can do to help the Alzheimer's patient get over the depression they are suffering. In our opinion, though, the main thing is to show them a lot of love and compassion, and always let them know you are there for them.

EATING AND FEEDING PROBLEMS 

Eating is a big problem for carers of Alzheimer's patients. Sometimes the patient wants to eat constantly, which is not healthy. You don't want them to gain too much weight, thereby creating other health related problems. On the other end of the spectrum, you have the patient who refuses to eat anything! So - why do these behaviours occur, and what can you do about it?

First of all, let's look at why the patient wants to eat all of the time.

There could be several different reasons why the Alzheimer's patient displays the behaviour of over-eating. Some of them include:

• The Alzheimer's victim's brain does not function as it once did. The person usually loses the ability to think logically and rationally. They may not have the capacity to realise that they are not really hungry.
• Emotional factors could cause the patient to over-eat. Food may perhaps make them feel more secure, less anxious or in control.
• Side effects of some medications may cause the victim to feel hungry most of the time.
• The patient could just be bored and find nothing to do except eating.
• Depression could be a factor in the desire to eat all the time. People with the problem of depression will usually display a change in eating habits.
• Memory loss could also be a possible cause of this behaviour. The patient may not remember that he or she just ate.

Here are some tips and possible solutions to help with the over-eating behaviour:

• Instead of giving the patient three meals a day, offer him or her five or six small meals a day.
• Keep a variety of low calorie snacks available, such as apples, celery or carrots.
• Try to get the patient to go for a walk or engage in an activity in order to take his or her mind off food.
• In extreme cases, you may have to lock foods up in your cupboards, especially if the patient is overweight or on a special diet.

Now, we'll take a look at some of the reasons why an Alzheimer's patient won't eat, and some possible solutions for that behaviour.

We've examined the problem of constant eating. Now let's look at the problem of not eating enough. There are many factors why a person with Alzheimer's disease won't eat. You will find a list of them below.

• Dental problems that may make eating painful, such as ill fitting dentures, sores in the mouth or an infected tooth.
• Anxiety or confusion can cause an Alzheimer's patient not to eat. If they are anxious or nervous, you may have a hard time getting them to sit still long enough to eat.
• Vision problems may cause the patient to not want to eat. They possibly may not be able to see the food clearly, therefore they cannot recognise what it is.
• Some medications such as anti-depressants may play a part in this behaviour. Decreased appetite is a common side effect of the anti-depressants.
• Memory loss is a key factor in this behaviour. The victim may have forgotten how to use the eating utensils, or he or she may have forgotten that they have to eat in order to stay healthy.
• Your loved ones could be suffering from agnosia. This occurs when the brain is not able to process what the eye is seeing.

• If you suspect a dental problem, make a dental appointment as soon as possible.
• Try keeping the atmosphere as calm as possible at mealtimes for the Alzheimer's patient. Try to curb any loud noises or other distractions before sitting the patient down to eat.
• If you think the patient's medication could be the reason they are not eating, try to discuss this with your doctor as soon as you can.
• If the patient has vision problems, try urging them to wear their glasses - especially at mealtime.
• When memory loss is to blame, see if the patient will mimic you as you go through the actions of eating (picking up your fork and putting it to your mouth). If the patient does mimic you, he or she may continue to eat once they taste the food. You may have to repeat this process at each mealtime.
• Try serving the patient finger foods. Sometimes this is easier for them and they will be more apt to eat.
• You might try serving just one food at a time, so as not to cause any confusion for the victim. They may not feel so overwhelmed with just one item at a time on their plate.
• Give the patient as much time as needed to finish their meal. Don't try to rush them, as this may only agitate them more.
• Alternate the food with beverages to keep the throat from becoming dry.
• You may have to demonstrate chewing motions to the victim so that they may mimic you.

In later stages of Alzheimer's disease, some patients have trouble chewing or swallowing. They may forget to chew at all and swallow their food whole. They could have lost muscle control or co-ordination. This could cause them to choke. Another common symptom of the later stages of Alzheimer's is drooling, which is most likely caused from weak muscles, medications or food being held in the mouth and not swallowed.

Below are some suggestions to help with eating and feeding problems in the later stages of Alzheimer's.

• Make sure dentures fit properly.
• Feed the patient foods that require little or no chewing. Some of these would be soup, cottage cheese, mashed potatoes, applesauce, scrambled eggs, pudding, yoghurt and milk shakes.
• Sometimes the Alzheimer's patient will lose sensation in their mouth. Gently move their chin to remind them to chew. Lightly stroke their throat to remind them to swallow.
• Try to serve the same texture foods during meals. You wouldn't want to serve foods like milk and cereal because the milk is liquid and the cereal is solid. The patient may get confused and not know whether to chew or to swallow.
• Make sure the patient is sitting up straight in his or her chair. When they get ready to swallow their food, remind them to tuck their chin (leaning head forward and tucking the chin down to the chest), as this aids in the swallowing process.
• For patients who are bedridden, try to make sure they are sitting up as vertical as possible to prevent choking. Make sure you use some type of covering to prevent spills on clothing or bedclothes. Use an oversized spoon filled about half full of food. If you apply slight pressure to the lower lip, the patient will usually be prompted to open his or her mouth. For patients that tend to hold food in their mouth, slight pressure with the spoon in the middle of the tongue will usually promote a swallowing response. You should also verbally prompt them to swallow.
• You should learn the Heimlich manoeuvre in case of choking. If the person can talk, cough or breathe, do not use this manoeuvre - if they cannot do this, then you must help!
• You may have to include nutritive supplements in your loved one's diet if they still aren't eating, as they should. Most of the time, even if the patient won't eat, you can usually get them to drink liquids.
• Make sure you do not use straws in liquids if the patient has a swallowing problem. This can cause them to aspirate (liquid going into the lungs) because the liquid goes into their mouth much faster than if they were drinking out of a glass. Aspiration can easily lead to pneumonia.

For some carers, bath time is a nightmare. Many times, Alzheimer's patients are frightened or resistant when it comes to taking a bath. There are many reasons why the patient may not want to take a bath. We'll examine some of those reasons below and also look at some suggestions to make bath time a more pleasant experience.

• Depression could cause the patient to lose interest in personal hygiene.
• Physical illness could also cause the patient to lose interest in personal hygiene.
• If the hypothalamus region of the brain (the body's 'internal thermostat' regulator), is damaged from Alzheimer's disease, this could cause a changed sense of perception of hot and cold water temperature.
• Brain damage could also cause a different sensation of water.
• Poor lighting and poor eyesight could play a role in not wanting to bathe.
• Not being able to find the bathroom.
• Lack of privacy.
• Room temperature too cold.
• Water too deep.
• Water too hot or cold.
• Fear of falling.
• Fear of water or of being hurt by it.
• A disruption in the daily routine of the patient.
• Unfamiliar carers, especially if home health workers come into the home to help with bathing, etc.
• The reason for taking a bath is forgotten.
• Humiliation of being reminded to take a bath.
• Agitated before starting the bath.
• Feeling of being rushed by the carer.
• Feeling embarrassed about being naked in front of another person.
• Fatigue.
• Fear of hair washing.
• Patient kept waiting too long while caregiver prepares bath.
• Fear of soap, wash flannel, running water, etc.
• In "the good old days", most people did not bathe and change their clothes as often as we do today. Taking a bath once a week may have been the way the person did things in his or her home, so bathing more often may be a source of upset to them.

PROBLEMS WITH BATHING: Helpful Advice

• Try to figure out the best time of day for the patient's bath. Try to stay with the person's old bathing routine before they developed Alzheimer's disease.
• Figure out when the patient is most relaxed, and what type of bathing they would prefer – bath, shower, stand up wash, etc.
• Make sure the bathroom is warm and inviting.
• Give the patient privacy. Pull down the blinds or close the curtains and doors.
• Provide plenty of lighting in the bathroom, especially in the evening.
• Try showing the patient bathing instructions written by a doctor on a prescription pad, such as: "Bathe 2-3 times weekly."
• Prepare the bath ahead of time. Make sure to check the water level.
• Lay out the soap, flannel, towel and clean clothes in sequence of use so that the patient won't have to wait.
• Use a calm, quiet tone when announcing that the patient's bath is ready.
• Explain to the patient one step at a time what to do. Combine visual cues if needed.
• If the patient refuses, don't argue with him or her to the point of getting them agitated. Wait until the person is in a good mood to try and get them in the bath.
• Let the patient feel the water before getting into the tub. This may help calm the person.
• If bathing is a difficult task, don't try to get them in the bath every day. A stand up wash daily and a full bath every week may be all right.
• Offer a reward for taking a bath, such as a favourite snack or activity.
• Try making the bath separate from the hair washing. It may make the patient less anxious about bath time.
• Play soft music in the background to try and soothe and calm the patient.
• Try giving the patient a flannel to hold for distraction while bathing.
• Wrap a towel around the patient's shoulders to make them less self-conscious about being undressed. It's very important to respect the person's privacy and dignity.
• Avoid forcing or arguing with the patient about taking a bath. This only causes further agitation.
• Avoid using a commode chair when giving a shower. This encourages the patient to be incontinent when bathing.
• Allow the patient to do as much of the bathing as possible.

Bathing is a very personal and private activity. It makes many people feel very embarrassed when someone sees them without clothes on. When a carer has to help a patient take a bath, it makes the person realise that they have lost their independence. It is important to realise that these feelings may contribute to some of the resistance to bathing.

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REPETITIVE ACTIONS

Many times, people with Alzheimer's disease or other types of dementia develop a behaviour that involves repeating the same questions or actions over and over again. This can be very annoying, but it helps to try and remember that this person very possibly does not remember asking that question just moments before. Here are some possible causes of the repetitive actions, and also some coping strategies that may help you, as the carer, be able to handle the behaviour much better.

• Physical changes in the brain from diseases such as Alzheimer's.
• Memory loss from dementing diseases.
• Side effects of medications. This is especially true for repetitive motions.
• Misinterpreting sounds or sights, thereby causing anxiety.
• Separation from loved ones, causing constant questions such as, "Where's my husband/wife?"
• Not understanding what is happening around the patient, resulting in questions like "What are you doing?"
• Inability to express needs. For example, hunger may be expressed in the form of repeating the question, "What's for lunch?"
• Trying to express emotions, such as fear, anger or insecurity.
• Distract the person with a favourite activity or a favourite snack.
• Respond to the emotion instead of the specific question. The person may simply need reassurance.
• Remind with simple, brief statements. Don't remind the person that he or she has asked the question before, as this could be upsetting to them.
• Try a gentle touch when verbal response doesn't help. Sometimes a hug or a gentle shoulder massage is more reassuring than words.
• Use a calm voice when responding to repeated questions.
• Use simple written reminders with patients who can still read. For example, a large sign hung in their room that says, "We will eat supper at 6:00 PM."
• For the patients who no longer read, use pictures instead. For example, a picture of a toilet may replace the word "bath room" on the bathroom door.
• Don't discuss plans with the person until just prior to an event, because it may cause agitation and repeated questions.
• Ignore the behaviour or question. If there is no response, the behaviour may stop. This must be used carefully, though, because sometimes the patient may become angry or frustrated if the carer does not answer them.
• Use memory aids. Sometimes signs, large numeral clocks and calendars will help orient some people.
• Remove things that may cause repetitive questions. For example, a coat stand with coats on it may cause the patient to ask, "Is it time to go now?"
• For repetitive movements such as rubbing hands together or tapping hands on the table, occupy the person with some sort of activity, a doll or a stuffed animal may be useful.
• Have the patient's medications checked by a physician, because sometimes certain medicine will produce repetitive action behaviour.

Remind yourself that the person with dementia does not have the ability to remember because of changes in the brain. It is sometimes helpful to keep a log or diary to help determine the causes of repetitive actions. Does the action occur at a certain time of day? Could the person be hungry, cold or hot? Keep track of when and what events have occurred, and you may be able to stop the behaviour before it starts.

Some repetitive behaviour, such as sticking the tongue in and out, can be caused by too much of a sedating medication. If this type of behaviour is occurring, you should be sure and tell your doctor.

Repetitive motions and questions can be one of the most frustrating behaviours for carers. It will help to try and get away for a while. Make a little time for yourself, and not only you, but also the patient will benefit.

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SLEEPLESSNESS

Sleeplessness can have many different causes. A popular theory of sleeplessness is that many older people don't seem to need as much sleep as younger people do. This is not necessarily so when it comes to people with Alzheimer's disease. Their sleep problems may be the result of mental changes in which the portion of the brain that controls sleep is damaged, or they could possibly be having dreams that disturb them. A lack of exercise and taking naps during the day could also be a cause of sleeplessness. First we'll explore the reasons why the person may not be able to sleep, and then we will look at some of the ways the carer may be able to help.

• Sleeplessness could be a side effect of medication the person is taking.
• Medical conditions such as diabetes, alcoholism, heart disorders, urinary tract infections and ulcers can all cause sleeplessness.
• Arthritis pain, leg cramps and breathing difficulties can also cause a person to not be able to sleep.
• Depression may cause a person to wake up very early, for instance at 2 AM. If they are using antidepressants, taking the dose at bedtime may help.
• Waking up in the middle of the night to use the bathroom can cause sleep disturbances. This can be a frightening experience for people who are confused.
• Caffeine consumption during the day can cause sleeplessness.
• If a person is hungry, this could be a cause of not being able to sleep.
• Disrupted sleep patterns due to progressive dementia. The ability to sleep is said to deteriorate as the mental functions decline.
• The patient could be too hot or too cold.
• Sleeping too much during the day.
• Not enough exercise.
• Agitation from an upsetting situation, such as a bath or an argument with the carer.

• Make a doctor's appointment for your loved one to help identify and treat any medical problems.
• Treat pain with an analgesic, if approved by the physician.
• Giving antidepressants at bedtime will help keep the patient from being so sleepy during the day.
• Have medications evaluated for side effects.
• Determine whether the patient is too hot or too cold upon awakening.
• Provide plenty of lighting during the evening hours. Darkness or shadows may contribute to agitation.
• Be sure to keep a nightlight on during the night, so that the patient can find the bathroom, if needed.
• A commode or urinal next to the bed may be an option if the person has trouble finding the bathroom.
• Make sure the patient uses the bathroom before going to bed.
• Make sure the bed is comfortable and familiar to the patient.
• Try to maintain a set bedtime and waking routine.
• Try bedrails on the bed. This may remind the person that they are in bed. You will have to monitor this closely, though, because this could lead to falls if the person tries to climb out of bed over the rails.
• Try to prevent daytime napping by getting the patient involved in an activity.
• Make sure the patient is getting adequate exercise.
• Cut down on caffeine products such as coffee, tea, soft drinks and chocolate. Eliminate ALL caffeine after 5 PM.
• Make sure the patient is not hungry at night. Try offering them a snack before going to bed. You might also try warm milk.
• Avoid any upsetting activities, such as bathing, in the late afternoon.
• If the person refuses to sleep in their bed, let them sleep on the couch on in a chair, if that is what they prefer to do.
• Try softly playing, soothing music when they go to bed.

Keep in mind - drugs that induce sleep should only be used under a doctor's supervision. Some patients that take sleeping pills become more confused and anxious. Try all other methods before you consider drugs.