It's the world's toughest job

Health: Alzheimer's caregivers must tend themselves too, or they and their patient will suffer.

March 26, 2000|By Mary B. Moorhead | Mary B. Moorhead,Knight Ridder/Tribune

If you are the caregiver or spouse of an Alzheimer's disease patient, you have the hardest job in the world. Whether it is fighting over bath time or medications, this 24-hour job is overwhelming.

Luckily, there are recommended approaches and excellent resources to support you. If you heed them and take care of yourself, you can avoid the depression which is common to many Alzheimer's caregivers.

First, your relative must have a professional medical assessment to rule out diseases that appear to be Alzheimer's but actually are other treatable illnesses. It is also very important to obtain a neuro-psychological test of memory and mental skills.

Clues that your relative needs an Alzheimer's (AD) assessment include a sudden personality change combined with losing daily living skills and significant memory capability. Perhaps a former bookkeeper can no longer balance a checkbook, or a fabulous cook can't remember the steps to a meal, or a formerly good driver has many accidents. Maybe your relative becomes angry and suspicious and forgets the month and year, your name, and entire conversations or visits that just happened.

I have had many clients come to my office convinced a parent does or does not have AD, based on, say, Internet information only. They are often very wrong.

The man who wanted to put his grandmother in adult day care for the rest of her life turned out to only have a relative who needed anti-depressant medications to resume her former activities. But another grandmother, "who did not have AD," according to her family, was completely lost in her own neighborhood and started fires by leaving the stove on.

Once you have a tentative AD diagnosis (AD cannot be completely diagnosed until an autopsy), use these tips.

* Establish a daily routine you can both rely on.

* Look carefully at the AD person's lifetime personality, routines and interests to choose pleasurable activities. Consider walking for walkers, gardening for former gardeners, or a glass of wine at "cocktail" hour.

* Do not try to use logic or persuasion to change difficult behaviors. Instead, distract, redirect and avoid "triggers." If your relative says her dark-chocolate cake is "burned," don't try to convince her it isn't; say, "Oh, you are right, let's have ice cream instead."

Triggers are anything in the environment, or in the person's mind, that cause agitation. They can include crowds, noise, fatigue, change in routine, a trip, reminders of past fears, or that burned chocolate cake.

You must be creative to locate the trigger. Again, the past and personality provide clues. Perhaps a bath is refused because the person never learned to swim or always hated to get her hair wet. Forcing the issue results in increased agitation. You must stop the trigger and calm the patient. Later on, try a different solution, perhaps a sponge bath in the kitchen.

* Ask your doctor for medications to soothe unsolvable agitated moments or situations where you must get something done. There are excellent medications that do not over-drug.

* Give yourself a respite from caregiving by hiring other caregivers or using an AD day-care facility. This is extremely important. Many caregivers refuse to take a break and become run-down and depressed. Both patient and caregiver suffer. Enjoy hobbies or work, socialize, join a support group, exercise and eat well.

* When caregiving is no longer bearable, please don't feel guilty. Find a good nursing home and then visit frequently.

Mary B. Moorhead is a licensed family therapist and elder-care specialist. Write to her c/o the Contra Costa Times, P.O. Box 508, Walnut Creek, Calif. 64596-0088. Or e-mail her at


The Alzheimer's Association


Alzheimer's Disease Education and Referral Center


Book: "The Best Friends Approach to Alzheimer's Care" by Virginia Bell and David Troxel (Health Professions Press, $24.95).

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