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Avoiding Extreme Summer Heat with Dementia

staying cool in summer heat when living with dementia

As we currently struggle to cope with the unusually high temperatures sweeping the US and overseas, it is important to consider what that might mean for people who care for those living with Alzheimer’s or other forms of dementia

It is important to realize that, as we get older, our bodies are not able adjust to high temperatures lo as well as they did when we were young, and we can lose the ability to perspire and to regulate our body temperature. Our skin also tends to become thinner as we age, and this reduces our protection against the sun.

We must bear in mind as well that some prescription medications can further reduce our natural ability to sweat, and thus impair our ability to regulate our temperature.

These risk factors have to be carefully managed in the case of a person living with any kind of cognitive impairment, as they may not be able to communicate any specific heat-related distress that they are experiencing. 

In fact, in some cases, they may not even notice the heat or discomfort because of changes in the way that their brain is able to process sensory information, or regulate their body’s awareness of and response to excessive heat.

Caregivers therefore must endeavor to keep the person in their care as cool as possible, while monitoring them for indications of heat-related stress. Here are a few suggestions to follow when experiencing unusually hot weather conditions:

  • This may seem obvious, but it makes it no less important – ensure that the person in your care is wearing cool clothing, such as light-weight, loose-fitting clothes, ideally manufactured from natural materials, such as cotton. 
  • Fresh air is good, unless it is heavy and humid outside, or oppressively hot. But make sure the person you are caring for wears a hat, or sits under a parasol or sun shade, when venturing outside.
  • Yes, it is expensive to run, but air conditioning is always good. You don’t need however to turn the house into a fridge, but keeping the temperature in the 80-85 degree range will have a significant positive impact. 
  • If air conditioning is just too difficult to keep running, you could perhaps combine a change of scenery with a cooler environment, by perhaps driving to a mall, or to a library, where some time can be spent in an air-conditioned space, as long as it is not too crowded.
  • Keep out of direct sun! Stay indoors during the hottest hours of the day
  • Make sure the person you are caring for drinks plenty of water or juice, but avoid alcohol, coffee or tea. Left to their own devices, people living with Alzheimer’s or other forms of dementia often forget to drink anything at all; some of them may not even feel thirsty, but failing to drink will lead directly to dangerous dehydration, causing potentially serious. health issues. 
  • Eat light meals and try to avoid using using the oven – that can increase the ambient temperature
  • Check medications: ask a physician if the person’s medications are likely to affect their body’s ability to regulate temperature, or otherwise increase the risk of dehydration.
  • Check in often: If the person you are caring for lives alone, check in with them every day, or ask a neighbor to look in several times a day. 
  • Look for indicators: a cognitively-impaired person may not be able to tell you when he or she is feeling hot or unwell. Also, older people may not sense the onset of worrying levels of heat as quickly as people who are younger. Specifically, look for:
    • Headache, nausea and fatigue; these can be signs of potential heat stress. 
    • Heat fatigue: dizziness, sweaty looking skin that is moist and cool to the touch, a weakened pulse, feeling faint. 
    • Heat stroke: this is life-threatening and requires  Immediate medical attention, as death can occur quickly when heat stroke occurs. Body temperature rises above 100 degrees, and the person may become confused, combative, behave bizarrely, feel faint, stagger. Their pulse is rapid, and their skin is dry, flushed and may feel hot, but there will be a lack of sweat. Breathing may be fast and shallow, and pupils may widen or dilate. At the extreme, delirium, seizures or convulsions, and coma are possible. 

If you encounter any of these issues, dial 911 or summon medical personnel immediately for emergency assistance and, while waiting, take these actions:

  • Have the person lie down in a cool place. 
  • Elevate their feet. 
  • Apply cool, wet cloths or water to the skin, especially the head, groin and armpits which cool quickly. 
  • Fan by hand or with an electric fan. 
  • If possible, give small sips of cool water

Below are links to product recommendations available on Amazon that you can use to stay cool, stay hydrated, and avoid the heat this summer season:

 Portable Neck Cooling Rechargeable Fan 

cooling neck hat for shade

Sun Defender Cooling Neck Guard Wide Brim Hat

clip on chair shade for sun protection

Adjustable Shade Umbrella with Universal Clamp

handheld mini fan for staying cool in summerMini Handheld Fan

REUSABLE FOLDABLE WATER BOTTLES FOR PORTABLE USE BPA Free Silicone Foldable Water Bottles 

cooling patches for heat and feverCooling Patches 

(These links do contain affiliate links that we may earn commission from should you choose to purchase)

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UCI Research into Aromas While Sleeping Showed Memory Improvement

aromas diffuser while sleeping research study shows memory improvement

UCI News reported in August 2023 that a University of California, Irvine, had announced that a research study into the impact of aromas while sleeping had sparked a 226% cognitive increase.

Research Excerpts Summary:

When a fragrance wafted through the bedrooms of older adults for two hours every night for six months, memories skyrocketed. Participants in this study by University of California, Irvine neuroscientists reaped a 226% increase in cognitive capacity compared to the control group. The researchers say the finding transforms the long-known tie between smell and memory into an easy, non-invasive technique for strengthening memory and potentially deterring dementia.1

The project was conducted through the UCI Center for the Neurobiology of Learning & Memory. It involved men and women aged 60 to 85 without memory impairment. All were given a diffuser and seven cartridges, each containing a single and different natural oil. People in the enriched group received full-strength cartridges. Control group participants were given the oils in tiny amounts. Participants put a different cartridge into their diffuser each evening prior to going to bed, and it activated for two hours as they slept.1

People in the enriched group showed a 226% increase in cognitive performance compared to the control group, as measured by a word list test commonly used to evaluate memory. Imaging revealed better integrity in the brain pathway called the left uncinate fasciculus. This pathway, which connects the medial temporal lobe to the decision-making prefrontal cortex, becomes less robust with age. Participants also reported sleeping more soundly.1

REFERENCES:


A Mind to Care’s Essential Oils and Diffusers available here.

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Should We Always Tell the Truth to Someone Living with Dementia?

dementia care tips lying and protecting emotional well being

Living with Someone with Dementia

Dementia is a devastating and progressive disease that causes a decline in cognitive function, memory loss, and behavioral changes. One of the most difficult challenges for caregivers and loved ones of people living with dementia is how to communicate with them effectively. One question that often arises is whether it is ever right to lie to a person living with dementia.

Is it Okay to Lie to Someone with Dementia?

Your initial response to the title of this blog post may have been, “Yes, we should always tell the truth,” and “No, we should never lie.” After all, lying is generally considered to be unpleasant, negative behavior, and most of us are taught from a young age that honesty is always the best policy. Many of us will be familiar with the famous quote from Sir Walter Scott in his great 19th century poem, Marmion, “Oh what a tangled web we weave, when first we practice to deceive.”

However, when one is grappling with the day-to-day real world challenges of caring for someone who is living with Alzheimer’s or another form of dementia, carers often struggle with how to deal with or respond to situations or questions where the person they care for is being difficult, unresponsive, hostile or even seemingly absurd, or completely disconnected from reality.

Some might advocate that telling the truth is always the best course of action, no matter how painful it might be to the hearer.  However, when it comes to communicating with a person living with dementia, the issue can sometimes be more complex than a simple foregone conclusion.

People with dementia can often experience confusion, disorientation, and memory loss, which can lead to anxiety and distress. In some cases, telling the truth can actually exacerbate these feelings and make the situation worse.

Creative Lying and Therapeutic Deception

Imagine that a person with dementia is constantly asking about their spouse who passed away many years ago. Telling them the truth, that their spouse is no longer alive, may cause them to repeatedly experience the grief and sadness that flowed from that loss. This can be distressing not only for the person living with dementia but also for their caregivers and loved ones. In such cases, it may be more compassionate and beneficial to tell a “therapeutic lie” instead, such as saying that their spouse is out shopping or visiting a friend.

In other words, many carers believe that it is better to not challenge the absurdity, or reality disconnect in what is being spoken of, but rather to engage with the discussion and take it further, both to keep engagement and discussion going and to avoid the potential consequences of stress, agitation and upset.

Patti Davis, the daughter of US President Ronald Reagan, in her memoir “Floating in the Deep End,” coined the phrase “creative lying,” and how this would cause him to be less flustered when he was worried about missing what he believed to be an important obligation.” 

At a caregiver seminar that I attended in California, a young man who was caring full-time for his mother living with Alzheimer’s, addressed the group and shared that sometimes, usually towards the end of any given week, his mother would start to become difficult, unwilling to communicate with him and even hostile. She would refuse to take her medication. He prefaced what he was about to say with the words, “I apologize if some of you here are offended by this,” and then told the group that when his mother became difficult like this he would pop into the next room and put on a wig and a pair of clear-lens spectacles. He would then go back into the room where his mother was and would greet her by name and introduce himself as “Dr. Wilson” and say that he had come to remind her to take her medication. On every occasion, his mother greeted the “Doctor” warmly and happily took the medication.”

Interestingly, no one in the room full of professional and non-professional family caregivers offered any criticism of his actions at all, as he had clearly found a way to dissolve a difficult situation and achieve a successful conclusion, even though his actions were rooted in deception. 

I also heard a story once about a lady caring for her father who was living with dementia and how he became extremely agitated one day because a college had not sent him his certificate of achievement. This was impossible to resolve, as he had had no connection or involvement with the College in question and was certainly not due any kind of certificate. After a week of seeing her father become increasingly upset, agitated and angry about the failure of the certificate to arrive, his daughter created a Certificate of Achievement and presented her father with it when he enquired as to whether or not it had arrived. Once again, a piece of deliberate deception, but it diffused a difficult situation, dissolved agitation and removed stress.

Protect the Person with Dementia’s Emotional and Mental Well-being

However, it is essential to note that what we have referred to here as Therapeutic, or Creative lying, should only be used when it is necessary to protect the person’s emotional and mental well-being, to eliminate stress or agitation and maintain emotional equilibrium. The word “lying” itself seems so harsh, so absolute, yet we need to remember that, by selectively lying to the person they are caring for, a caregiver is actually supporting that person’s reality; lying to a person with dementia may be the right way to care for that specific person at that specific time because, depending upon the progression of the disease, they may be wholly unable to remember the truth, and repeatedly telling them they are wrong, or insisting on facts will simply cause them distress or pain. As the Alzheimer’s Association has stated, “it is important to put oneself in the shoes of your loved one, and acknowledge how frightening their situation must be.”

It must be noted that not everyone agrees that therapeutic or creative lying is ever the correct decision; they believe that distraction, or gently changing the subject, or rephrasing the question or issue can be just as effective at restoring calm or dissolving stress. This school of thought relies on a gentleness of response that soothes someone with dementia by essentially, avoiding or stepping around the problem or question that is causing anxiety. This approach does tend to assume that the person looking for their loved one, or worrying about a non-existent upcoming meeting, or waiting for a certificate in the mail, will either forget whatever is distressing them, or realize they were mistaken, or even eventually remember the correct facts and thereby peacefully move on.

A Complex and Sensitive Choice

In conclusion, the decision to lie or not to lie to a person with dementia is a complex and sensitive one and people may well have different and sincerely held views. But there does seem to be a significant body of real world evidence that suggests that therapeutic, or creative lying may sometimes be the best option to keep a person calm and maintain their emotional equilibrium. Ultimately, the decision to lie or not must be made on a case-by-case basis, taking into account the person with Alzheimer’s individual needs and circumstances.

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Agitation

Agitation: Common Dementia Symptom

Although it has perhaps not received the attention that it deserves, the issue of agitation is a common symptom in people living with dementia. It can be one of the most complex and stressful challenges to manage for caregivers.

It is estimated that more than half of people living with dementia may experience some degree of agitation at some point during the course of their illness and it is considered to be one of the core features of behavioral and psychological symptoms of dementia.

Agitation can manifest in various ways including verbal or physical aggression, restlessness, wandering, pacing, gesturing, profanity, and refusal to cooperate with caregivers. The effects can have far-reaching impact on caregivers. It has been linked to accelerated disease progression, functional decline, and decreased quality of life and is also a significant cause of caregiver distress.

In severe cases, medication may be required, including antidepressants and anxiolytic drugs. But wherever possible, priority should be given to non-pharmacological treatments or interventions, subject, of course, to professional healthcare advice.

No two individuals are identical and clearly what works for one may not work for another . But perhaps there are simpler and easier areas that a caregiver can examine first, hopefully without needing recourse to medication.

Here are a few suggestions:

Alleviate Physical discomfort

Perhaps at the top of the list is physical discomfort caused by, for example, pain, hunger, or thirst; each of these may trigger agitation. Consequently caregivers should always be aware of the individual’s basic needs, and try to ensure that they are met promptly. In fact, pain management is particularly important, as people with dementia may not be able to effectively communicate the level of pain that they are experiencing.

Our mood pointer sheet can be a helpful tool for those who have difficulty with speech.

Be Aware of Medication Side Effects

The side effects of medication can also sometimes cause agitation; some medications, such as antipsychotics, can have serious side effects. It probably goes without saying that caregivers should always work closely with relevant healthcare professionals to manage medications effectively to ensure that they are necessary and appropriate.

Minimize Environmental Triggers

Agitation may also be triggered or exacerbated by environmental conditions such as loud noises, very bright lights, “loud,” or very bold colors in rooms, or even unfamiliar surroundings. To minimize this, caregivers should try where possible to create a calm and familiar environment that minimizes noise and other distractions. (See our blog post on Colors and Dementia)

Maintain Routines

It is also true that the use of structured routines, coupled with familiar activities can work to reduce agitation as well as improving the individual’s overall sense of well-being. Allied with this, unmet needs, such as boredom, social isolation, or a lack of any meaningful activities, can also potentially contribute to agitation for someone living with dementia.

To try and avoid this, caregivers should identify any particular interests and preferences that the individual they are caring for has, or had prior to contracting the condition, and come up with activities that speak to or resonate with those interests.

In one example is a gentleman who had been a CPA in his professional life. His son found that activities that involved sorting coins seemed to particularly hold his attention and provide enjoyment for him.

It is clear that social engagement can definitely improve the individual’s quality of life and reduce agitation. This was the inspiration behind the development of the A Mind to Care Game & Activity Kit .

Gentle Touch

Although people do behave and react in different ways, it is true that touch can also be an effective way to reduce agitation in certain individuals living with dementia. A gentle touch, such as hand holding can have a calming effect and also provide a sense of comfort, security and reassurance, and can alleviate feelings of anxiety, restlessness or agitation.

Touch can also provide gentle sensory input and promote a calming effect; activities that involve touch such as providing a soft blanket, or tactile objects, such as fidget boards, can help to engage the senses and help to reduce agitation.

It is important of course to approach touch with respect and sensitivity, always obtaining consent and considering individual preferences and comfort levels.

Music

There have been numerous studies that have confirmed the benefits of musical intervention in reducing agitation in people living with dementia. This can be either active, where the individual participates in singing, dancing, or playing a musical instrument, or it can be passive, where they listen to music.

There is plenty of evidence that music seems to have a unique ability to evoke emotions and trigger memories; even for people living with advanced dementia, music is able sometimes to tap into deep-rooted emotional responses and stimulate positive feelings, and these emotional connections can help to reduce agitation and anxiety.

For a moving example of the power of music take a look at this YouTube video showing Lady Gaga and Tony Bennett Lady Gaga & Tony Bennett – The Lady Is A Tramp (One Last Time: Live At Radio City Music Hall, NY) HD – YouTube

Although agitation is a common dementia symptom, look for ways to prevent and minimize agitated behavior of the person living with dementia with these tips.

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Understanding the Benefits of Cognitive Stimulation Therapy for Dementia Patients

cognitive stimulation therapy

Cognitive Stimulation Therapy (CST) is a non-pharmacological treatment for people living with dementia. It is a structured program that involves engaging in group activities and discussions designed to improve cognitive function, memory, and quality of life for people with dementia. CST is a person-centered therapy that focuses on the individual’s strengths, abilities, and interests. In this blog, we will discuss the benefits of CST for dementia patients.

Cognitive Stimulation Improves Cognitive Function

Cognitive Stimulation Therapy has been shown to be effective in improving cognitive function and sort-term memory in people with dementia.

The program is designed to stimulate the brain and encourage participants to engage in activities that require cognitive processing, such as memory games, puzzles, word games, and discussions.

Research has shown that CST can improve memory, attention, and language skills in people with dementia, which can help them to maintain their independence and improve their quality of life.

Reduces Behavioral and Psychological Symptoms of Dementia

Behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia. These symptoms include agitation, aggression, anxiety, depression, and social withdrawal. CST has been shown to reduce the severity of these symptoms, leading to improved well-being and quality of life for people with dementia. The program provides a structured and supportive environment that can help to reduce anxiety and increase socialization among participants.

CST Increases Socialization and Communication

Socialization and communication are important factors in improving the quality of life for people with dementia.

CST provides a structured environment that encourages socialization and communication among participants. Group discussions and activities provide opportunities for participants to interact with each other and engage in meaningful conversations. This can help to reduce social isolation and improve mood in people with dementia.

Supports Caregivers

CST is not just beneficial for people with dementia; it can also provide support for caregivers. Caregivers often experience high levels of stress and burnout, which can affect their ability to provide care for their loved ones.

CST provides a structured and supportive environment for people with dementia, which can help to reduce the burden on caregivers. In addition, caregivers can participate in the program, which can provide them with a much- needed break and support system.

In conclusion, Cognitive Stimulation Therapy is an effective non-pharmacological treatment for people living with dementia. It provides a structured and supportive environment that encourages socialization, communication, and cognitive stimulation. CST can improve cognitive function, reduce BPSD, and improve quality of life for people with dementia. It can also provide support for caregivers, which can help to reduce stress and burnout. If you are caring for someone with dementia, consider incorporating Cognitive Stimulation Therapy into their care plan.

A Mind to Care Game & Activity Therapy System provides CST Activities

The use of A Mind to Care Game & Activity system includes cognitive stimulation activities, such as word games, puzzles, ability to use pictures to discuss present or past events or other topics of interest, and more. Our game and activity therapy system may be a nice way to start with cognitive stimulation therapy with your loved one living with dementia.

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Adaptive Interaction and Nonverbal Communication in Dementia

Alzheimer's dementia communication cognitive non verbal

Adaptive Interaction and Dementia

Adaptive Interaction is a term that describes a method of communication that can help caregivers connect with people living with dementia who have lost the ability to communicate verbally. It is not difficult to learn and it can help to provide contact and engagement, even as the dementia advances.

A common effect of advancing dementia is that the ability to speak can be gradually diminished, until people retain little or no capacity for verbal communication, relying instead on sounds or movements. Despite this, research has shown that people living with advanced dementia do still retain the desire to communicate. (Ellis & Astell, 2006)

This is important, as often people who have lost the capacity for speech are regarded as being withdrawn and consequently shut off from the world around them. Being able to communicate without speech can reduce social isolation, improve quality of life and allow more opportunities for caregivers to engage with people living with advanced dementia.

Connection is Instinctive

Everyone is born with an instinctive desire to connect with other people. We see this in the way a baby will attempt to communicate, perhaps by smiling, crying, opening and closing their tiny hands, or making eye contact. As adults we recognize, enjoy, and respond to these actions, often encouraging them by imitating the sounds and gestures that the baby is making. By mirroring these actions we enable and encourage the baby to engage in social interaction, even before they are able to speak.

Social connection is something that we take for granted, but research indicates that it could also be a key skill that could help us to engage with people as they age and lose the ability to communicate verbally. The way we interact with babies may, in fact, hold the key to how we might communicate with people living with advanced dementia who have lost the capacity to speak.

Mirroring and Observation

Viewed through the lens of Adaptive Interaction, seemingly random actions by people living with advanced dementia, such as tapping, crying out, or repetitive bodily movements can be interpreted as possibly communicative, as opposed to random, or even problematic. It may be, in fact, that by copying, or mirroring the actions, and by paying attention to the mood of the person involved, the caregiver might find a way to communicate with someone unable to speak. More importantly, those individuals with dementia may once again, experience human connection and engagement with their loved ones.

The key principle of Adaptive Interaction is to view all behavior, such as sounds, movements and facial expressions, as potentially intentional attempts to communicate. This approach is primarily based on carefully looking for and observing actions such as sounds, movements, eye contact, gestures, etc., made by the nonverbal partner. These observations can then be used to try to develop an understanding of the ways in which the individual may be attempting to communicate. As these hypotheses are created, the observer can then experiment with reflecting back, or imitating (mirroring) these actions, which may develop into nonverbal conversations.

The actions in question can and will vary enormously from person to person. As mentioned above, examples may include tapping on a surface, touching hands, facial expressions, clapping, movement of feet, other bodily movements, smiling, or even crying out..

It is important to understand that Adaptive Interaction is not a panacea that will fit every person and every circumstance. Equally important for it to be beneficial, the caregiver must genuinely want to connect with the person involved, otherwise it could degenerate into simple mimicry, which would be harmful.

There is a lot of research and a lot of literature available on the subject of Adaptive Interaction and, for any caregivers struggling to communicate with someone who has lost the capacity to speak, it is potentially a valuable skill to investigate and learn.

If you need any assistance in connecting with additional information on the subject of Adaptive Interaction, contact us at customerservice@amindtocare.com and we will endeavor to connect you with material that will be helpful.

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A sign of dementia is Rummaging – why does it happen and how do I cope with it?

a sign of dementia is rummaging

A Sign of Dementia: Rummaging

It is not uncommon to see someone living with dementia repeatedly rummaging through drawers and cupboards, often seemingly rearranging the contents, or emptying them out and then putting the contents back; they might then move to a different drawer or cupboard, and start the whole process again.

This behavior is known as rummaging, and it is something that does sometimes manifest itself as Alzheimer’s Disease, or other forms of dementia develop.

It is important for a caregiver to recognize rummaging as a sign of dementia, and to understand what it is and have a strategy to cope with it when it occurs. Otherwise, rummaging is an activity that can be extremely frustrating to watch because, frankly, it can create a real mess in a tidy room! In some cases, entire drawers may be emptied out, with the contents either strewn around the room, or perhaps hidden in different places. This can be challenging at the end of what may have already been a stressful day.

Why does it happen?

Rummaging may manifest itself as an expression of anxiety on the part of the person living with dementia; it may be that they are anxiously looking for a specific item that they believe they had placed in that drawer. If they can’t find it, they might jump to the conclusion that it has been stolen.

However, rummaging may also manifest itself as an enjoyable activity, where someone is simply looking through familiar items that bring comfort. It’s not uncommon for someone living with dementia to feel happier if they are surrounded by, or close to things that bring them comfort. So this sign of dementia can sometimes lead them to remove items from one location in order to hide them, or even hoard them somewhere else.

Equally, rummaging may be a manifestation of simple boredom; having a good “sort out” can be a way of finding something to do.

Rummaging is basically a coping mechanism — a way for the person living with dementia to cope with disorientation, or insecurity that is caused by the condition they are living with.

How do I cope with rummaging?

The first step is to take a breath and remember that it is the dementia that is causing the person you are caring for to rummage. It is absolutely not the case that they are deliberately doing this to bother you and add to your already heavy workload. Understanding and remembering this will help you to respond without arguments, which will avoid conflicts. Remember: rummaging is a symptom and sign of dementia. This in turn will lower the stress level for you both.

While the first instinct, particularly for someone with an orderly, tidy mindset, might be to put a stop to the rummaging. It is important to take a moment and try to understand why it is happening, and perhaps take steps instead to “manage” it rather than stop it. Particularly if, as mentioned above, when it is an activity that seems to be bringing comfort, or alleviating boredom for the person doing the rummaging.

Trying to stop the rummaging may increase levels of paranoia or agitation, raising stress levels and the potential for conflict. This is far less likely to happen if the rummaging is managed, rather than prohibited.

How to manage the rummaging activity:

  • Remove from all accessible drawers and cupboards any potentially harmful items. Make sure, for example, that things such as scissors, knives or needles have all been removed and stored somewhere that is either locked, or inaccessible. Remember that cleaning fluids may be confused with simple beverages and keep them somewhere safe.
  • If the rummaging activity does appear to be based on anxiety, try to find out what is driving that anxiety. Are they looking for a specific item which they believe might be in that drawer but does seem to have been misplaced? Some caregivers in this situation found a replacement item that looks the same or similar, which has solved the anxiety that had caused the rummaging.
  • Rummaging may extend from a drawer or cupboard to a refrigerator, so keep an eye on food items that may be past their sell-by date, or raw meats. Either remove them or try to make them inaccessible.
  • Take steps to remove any valuable or important items – cash, jewelry, keys, passports or credit cards and keep them somewhere inaccessible.
  • Consider creating a Rummaging Box, or Drawer, that is filled with familiar items, or items that you know may trigger happy memories, such as family photographs, or items that are familiar and special, such as a purse, clothes, or scarf or other mementos. Going though these things can provide a positive experience and a connection to good memories, which can increase feelings of comfort or security.
  • Keep trash cans out of sight, if possible, as someone rummaging may not be able to discern the difference between them and a drawer or cupboard. It is also a good idea to check the contents of the trash can before disposal, to make sure that no items have been hidden or placed in there that should not be thrown away.
  • Rummaging can take place anywhere in the house so try to keep restricted access to certain rooms.

In summary, rummaging is a sign of dementia and Alzheimer’s.  A patient and well thought out approach to rummaging can address its challenges and even turn it into a worthwhile and fulfilling activity.

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Dealing with Sundowning

sundowning

What is Sundowning?

Dementia is a general term for any condition encompassing memory loss, mental confusion, mood changes and other cognitive impairment issues that increasingly have a detrimental effect upon the ability of the person living with the condition to maintain a normal daily life. Within the scope of dementia, Alzheimer’s disease accounts for possibly up to 80 percent of all dementia cases.

Every person and every case is unique, but some symptoms will be common across many people living with the condition, and one of them is known as Sundowners Syndrome, or Sundowning.

Sundowning is the term given for a situation where a person living with Alzheimer’s disease and other types of dementia may start to experience a worsening of symptoms as the day begins to draw to a close and nightfall approaches.

At present, there is no definitive explanation as to why sundowning occurs, but it is believed that it affects something like 20% of all Alzheimer’s patients.

The progress of Sundowners Snydrome often appears to be in step with the progression of the Alzheimer’s disease itself. As the dementia worsens, so often does the recurrence and severity of the sundowning.

There is still a degree of mystery and uncertainty as to what exactly causes sundowning. There are a number of scientific and medical theories as to what may cause the phenomenon, and there are also believed to be certain “triggers,’ which can either cause or exacerbate it, but it is certainly something that Caregivers should be aware of and ready to try and manage, as far as possible.

The leading theory is that, as the condition of the Alzheimer’s patient worsens, the disease causes neuro-chemical changes in the brain that start to affect the internal biological “clock” of the patient; this can interfere with the part of the brain that would normally signal to a healthy person that it is time to wake up or go to sleep.

When someone experiences sundowning, it does not create any new symptoms, but rather it tends to exacerbate certain of the existing symptoms that the person has already been experiencing, particularly symptoms that adversely affect behavioral characteristics, rendering the person increasingly agitated, irritated, reckless and more and more difficult to manage.

Caregivers have reported that some people experiencing sundowning can become increasingly angry, irritated, anxious, agitated, paranoid and depressed; some even can become violent, hallucinatory, or overly emotional or upset and unable to sleep. Sleep deprivation itself can then contribute to a vicious cycle that can trigger further sundowning episodes.

Sundowning can start to occur from late afternoon and continue until late at night, and this can be especially challenging for a caregiver who may be already exhausted. It then tends to fade and the patient will return to a more normal state.

Common Sundowning Triggers

Sundowning can also potentially be triggered by certain situations or circumstances, and these could include:

  • Fluctuations in light levels – both low light and too much light have been found to be a trigger
  • Depression
  • Boredom
  • Lack of sleep
  • Hunger
  • Pain
  • Raised stress levels
  • Social isolation
  • Infection, such as a urinary tract infection

There is no cure yet for Alzheimer’s disease and, as sundowning is a known symptom that may manifest itself as the disease progresses, there is nothing that can be done to eliminate the phenomenon.

All a caregiver can do is be aware of the potential triggers and avoid them as far as possible, and to be ready to deploy strategies that have in some cases been seen to help manage the symptoms.

Management Strategies:

  1. Try to remain patient and calm

This is perhaps the most difficult of all things to implement, as dementia patients can often be extremely difficult to manage. In such circumstances, patience can be extremely elusive, but a raised voice, or sudden movement or changes in circumstances can worsen the situation

  1. Are there any immediate needs that can be met?

As mentioned above, feelings of hunger, thirst, lack of sleep, or pain, can potentially trigger a sundowning episode.

  1. Create a peaceful and tranquil setting as the day moves into the afternoon

Perhaps consider drawing the curtains early – this will reduce any lowering of light levels in the room as the outside light fades, as this has been noted as a potential sundowning trigger. A tranquil environment, with no distractions also can help, as will reducing noise, or the number of people in the room.

  1. Try to keep the patient active during the day

If possible, try to engage the person you are caring for with activities that will occupy their attention. One of the challenges in caring for someone with dementia is that they are often likely to nap during the day; this makes it harder for them to sleep at night. Board games, puzzles, craft exercises, even watching a favorite movie or TV show can all help.

A Mind to Care was born from a desire to make simple games and activities available to caregivers seeking to engage and retain the attention of people in their care. Many studies have confirmed that activities that engage the mind can significantly increase general well being.

Regular physical exercise can also help.

  1. Diet

Pay close attention to diet. Try to avoid caffeine or high sugar intake, particularly in the afternoon and strive where possible to maintain a good nutritional diet. Avoid alcohol.

  1. Stay Secure

One adverse effect of sundowning is that the patient may become prone to getting up at night, pacing the room, or trying to leave the home. It may be wise to fit locks on doors and windows, and perhaps a gate to prevent access to stairs, to avoid an accident or the patient wandering away and getting lost.

  1. Get some air

A brief walk or a short sit outside can be beneficial, as it is believed that exposure to daylight can help the body to reset its internal clock.

Other Resources about Sundowning are Available

There are many online resources providing advice and support on this and other issues facing caregivers; if you need help finding advice, let us know and we will steer you in the right direction.

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Taking Care of the Caregiver Benefits Both

The well-being of the family caregiver can have a direct impact on the quality of life of the dementia patient.

Family Caregiver –  Labor of Love

It is the hope of most folks to be in their own home for as long as possible. Home caregivers (usually family members) make this possible longer for people who suffer from dementia or other neurological or physiological conditions by helping their loved ones adapt to and cope with limitations in ability, mobility, communication and cognition.

The caregiver is constantly working to stabilize or lessen the progression of disorders with exercise, nutrition, activity, hygiene and generally some mix of medicinal schedules. It can be a very hard and often heartbreaking job, yet so many take it on as a labor of love.

A Healthy Caregiver Benefits Both Themselves and the Patient

Studies have shown that “the health and general well-being” of a family caregiver can have a direct impact on the quality of life and success of therapy for dementia patients in their care.

Additionally, research indicates that dementia patients have higher rates of behavioral symptoms and mortality when cared for by carers who are stressed, use emotion-based coping (e.g., wishing that the disease would go away), or negative communication strategies.

Effective Coping

If you are a family caregiver, finding an effective coping mechanism for both you and the loved one you are caring for are important. Everyone’s health and well-being are interconnected and interdependent.

Happily, there are many resources for the family caregiver to call on to help with the daunting and difficult task of providing home care for their loved one. Understanding the changing needs and communication strategies of their charges is an important factor in successfully managing a home care situation.

One such sources was provided by the Lewy Body Dementia association, found online here.  This document helps to set expectations about caring for people with dementia, and also offers a helpful section titled “Care for the Caregiver” that includes common sense suggestions for maintaining personal equilibrium in the face of such demanding and difficult work.

Use tools and resources to make caregiving easier and pleasant for you and your loved one. As possible, share in activities you both enjoy like games, puzzles, and looking at old photographs. Our Game & Activity Therapy System is made just for this – to help engage those with Alzheimer’s, dementia or other cognitive impairment in a positive activity.

How Do You  Know You Need Help?

Caregivers are less likely to prioritize themselves and may not spend time on preventive health services such as checkups. They are therefore at higher risk of health issues, even increased risk of premature death. 

Do you have any of these signs?

  • insomnia
  • exhaustion
  • ill-tempered
  • feeling of being sad
  • loss on interest in hobbies you once enjoyed
  • skipping personal care tasks
  • overuse of alcohol or drugs

The National Institute of Aging provides suggestions for caregivers to care for themselves.

Get Support

Remember, it is NOT selfish to take care of yourself when you are a caregiver. It’s important for you to do so for both your own well-being, as well as the person you are caring for. 

Join a caregiver support group. A support group can help you share your feelings in a safe environment among those who can understand what you might be feeling. 

Our Caring for the Caregiver is a 52-week paperback journal, designed to cultivate self-reflection, gratitude, well-being, and stress management for caregivers.

Utilizing a trusted in-home care agency can provided needed respite is another option.

Many other sources for information and helpful resources for the caregiver can be found online, with many different organizations providing helpful resources for home caregiving needs.

We’re Here to Help

A Mind to Care was created to contribute quality of life to others.  So if you need help with finding and connecting with useful resources, drop us an email at customerservice@amindtocare.com and we’ll be happy to pass on any information we have available.

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Dementia and Excessive Sleepiness

Excessive daytime sleepiness can be a problem for many folks, especially the senior population. There are also links between diseases like with conditions such as Parkinson’s, Alzheimer’s, and other forms of dementia and sleepiness as well. One common cause of excessive daytime sleepiness is related to inadequate or fragmented nighttime sleep.

How to Improve Sleep Quality

If you are able to identify the issues preventing adequate nighttime sleep, eliminate them to alleviate excessive daytime sleepiness. Barring that, here are some non-drug treatments tips to help your loved one stay active throughout the day and prepare them to increase their ability to get a full sleep at night, hopefully without interruption:

  • Participate in activities that may be helpful in providing stimulation to prevent daytime dozing.
  • Get physical exercise appropriate to your level of functioning, which may also promote daytime wakefulness.
  • Avoid sedentary activities during the day.
  • Get exposure to natural light.

In addition to the tips above to get a full night’s sleep, the following are suggestions to improve your loved one’s sleep routine:3

  • Establish good sleep hygiene, including a set bedtime and wake-up time.
  • Avoid caffeine and alcohol in the afternoon and night.
  • Limiting television viewing during periods of wakefulness, and not viewing in bed
  • Create a relaxation ritual before you go to bed.

Do you wonder if dementia and sleepiness are connected?

Excessive sleepiness can also be a resulting condition of Alzheimer’s disease and a number of other dementias.

Daytime napping and “sundowning” can be serious issues for those with dementia. As sleep and the quality of rest obtained can have a large impact on both physical health and quality of life, sleep issues may negatively affect every aspect of an individual’s life.

People with dementia, especially those in later stages, may spend a lot of time sleeping. Although the reasons why dementia affects sleeping patterns are not thoroughly understood, Alzheimer’s Society states that as the disease progresses, the damage to a person’s brain becomes more extensive and they gradually become weaker over time. This makes doing even tasks that we consider simple, like communicating and eating, tiring to the person with dementia.1 As a result, they will sleep more to recuperate.

Parkinson’s Disease and Sleep Disorders

Excessive sleepiness and other sleep disorders are also prevalent with those suffering from Parkinson’s Disease. Symptoms may also include insomnia, restless leg syndrome, and REM sleep behavior disorder. 2

Some Medication can Cause Sleepiness

Some medications contribute to sleepiness as well. The tips listed above may help mitigate the issue, even if there is also a pharmacological element involved as medicine prescribed may contribute to sleep disruption issues. Be sure to understand the side effects of their medications.

Consult Healthcare Professional about your Loved One’s Dementia and Sleepiness

If the person doesn’t appear well in other ways, you may want to consider consulting with your loved one’s healthcare professional to rule out an infection or other condition that could be affected their sleep. You may also want to have a discussion if you are concerned about any of the medicines. In addition to careful consultation with your doctor concerning sleep disruptions, other medical issues, and drug interactions, there are a number of non-medicinal approaches to improving sleep habits and minimizing sleep disrupting conditions.

Important ones to keep in mind among the recommendations for better sleep habits is the discouragement of daytime napping and the encouragement of participating in more activities during the day. A Mind to Care’s Game & Activity System is one way to encourage cognitively stimulating activities for those with Alzheimer’s, dementia and Parkinson’s disease.


1 Alzheimers.org
2 National Institute of Health | National Library of Medicine
3 Parkinson Foundation