After you take this class, you will be able to:
- List the signs of Alzheimer’s
- Discuss the stages of this
- Provide quality care to
patients with Alzheimer’s disease.
What is Alzheimer’s Disease?
Alzheimer’s disease is a very common problem among older adults. It is
sometimes found in younger adults but it is most often seen in older adults.
Nursing assistants and others provide care to patients with Alzheimer’s disease
almost on a daily basis. The class will give you the information you need to
make sure that you are giving these patients the best
care possible you can.
This disease continues to get worse after it starts. There is no cure for
it. People with Alzheimer’s disease can not think and act in a normal way when
they get to the last or worst stage of this disease. Some very known people,
like former U.S. President Ronald Reagan, have it.
Some people become completely dependent on others for their care and basic
safety needs become very great. When this happens, the patient can no longer
live on their own. They need the help of healthcare
workers, like a nursing assistant. Some patients live in their own homes with
the help of home healthcare aides and a home health agency. Others live in a
nursing home or in an assisted living home because they need the care that they
will get in these places.
This class will teach you about Alzheimer’s disease, some of its signs and
how you, the nursing assistant, can take care of people that have it.
What are the Signs of Alzheimer’s Disease?
The 3 stages of Alzheimer’s disease are:
- The early stage
- The middle stage
- The late stage
The signs of this disease get worse as time goes on and the disease
continues to progress. The signs of each of the 3 stages are below.
The first sign of this disease is usually short-term memory loss. The person
may forget things that have recently happened. They can remember things that
have happened a long time ago but they may not be able to remember what they
had for lunch or dinner the day before or they may not be able to find their
car keys because they forgot where they put them the day before. These people
can remember things that happened a long time ago (long-term memory) but they
forget things that are recent (short-term memory loss).
People in the early stage also:
- Repeat what
they have already said. They forget what they have already said when
they are speaking with other people.
- Forget the
word they want to use. These people just can not find the right word to
use in a sentence. They may even use a word that makes no sense at all.
- Forget how to
do some simple things. Some may forget how to make their favorite stew,
- Stop being
able to do some “hands on” things. They may no longer be able to knit
or drive a car as well as they did in the past.
personality changes. They may become angry, aggressive, depressed and
They may forget what day of the week it is.
Some of these changes are very small and hard to notice. It is often the
family that notices it. The person may not even know they are having trouble.
The Middle Stage Signs
As it continues to progress, the person will become more forgetful, confused
and disoriented. They will have both short-term and long-term memory loss. The
early stage signs get worse during the middle stage and the patient may also:
- Be restless
and confused at night. This is often called “sun downer’s”.
- Have trouble
reading and writing.
- Repeat actions
over and over again. These acts have no purpose but they are done
over and over again anyway.
- Wander and get
This is a big safety concern.
- Be at risk for
Falls, self harm and getting lost are a problem. These patients no longer
see and stay away from danger. They do not have good judgment and common
aggressive and very angry. These behaviors may place the
patient, staff and other patients at risk for harm.
- Not recognize
family, friends and familiar place.
- No longer be
able to take care of themselves without the help of others.
hallucinations and delusions.
They may be sad and depressed, have fears, anxiety and other personality
- Lose social
These patients may stop spending time with others and doing things that
you used to like doing.
The Late Stage Signs
During the late stage, the patient can no longer care for himself or
herself. They need complete care. All of the early and late stage signs
continue to get worse and the patient also:
- Loses control
They become incontinent of urine.
- Loses control
They become incontinent of stool.
- Can no longer
eat without a lot of help or a feeding tube. Patients may
have eating and swallowing problems..
underweight and thin. These patients are at risk for malnutrition,
dehydration, infections and aspiration.
- Is highly
- Very sleepy
and not responsive.
How do People Find Out that They Have
The diagnosis of Alzheimer's disease is not easy in the early stage of the
disease. It is hard to separate normal forgetting things from the short term
memory loss that marks this disease.
The doctor diagnoses this disease after a complete history and physical
examination of the patient. Some mental tests and laboratory tests are also
done. There is no blood test for Alzheimer’s disease. The lab and mental tests
that are done help the doctor to rule out other diseases that may be causing
the patient’s memory loss and other signs.
Caring for Alzheimer’s Patients
Nursing assistants and others in healthcare provide care to Alzheimer’s
patients according to their own needs. For example, if a patient in the early
stage of the disease is able to dress and bath without help, we should help
them to remain as active and as independent as possible. If the patient is at
risk for falls, we must make sure that their room and the nursing unit is safe,
secure, neat and uncluttered.
Below are some Alzheimer’s disease health problems and ways that nursing
assistants must provide care, as specific to these problems.
- Keep the
patient care area bright.
stimulation and noise to a minimum.
- Use large
clocks, calendars and other things to orient the patient. Spend time
with the patient. Remind them about the date, time of day and where they
Falls and other safety risks.
- Keep the patient
care area safe.
Safety is VERY important. Keep the patient’s room and the patient care
area. Take away all clutter and dangerous chemicals, like medicines and
cleaning liquids. Use non skid slippers and shoes for those at high risk
- Answer call
- Follow patient
identification procedures. Very careful patient identification
must be used to prevent medical errors and mistakes.
- Use and attend
Bed alarms, alarms that ring when a wandering person tries to leave the
building help keep patients safe. Listen for and respond to alarms
- Try to
re-direct wandering. Some nursing homes have wandering or exercise
tracks so that people can safely wander outside the building and in a big
circle that ends in another entrance to the same building.
Lack of rest.
- Alternate rest
periods with activity. Tired patients may act out with behaviors that
are disruptive, unacceptable or dangerous.
sleep and rest by keeping a regular bed time. Give the
patient a quiet room for rest. Have the person change into pajamas and
keep a regular routine so that the person is able to sleep at night.
- Encourage as
much independence as possible.
- Know what the
patient can and can not have. Some patients with a swallowing
problem can not have plain water or other liquids. They may need honey
thick fluids instead.
The best way to manage poor behavior is to prevent it. The best way to
manage it is to stop it before it starts. The prevention of poor behavior needs
the help of the whole team, including nursing assistants.
PREVENT poor behaviors.
- Know your
patients and residents. Know what kinds of things lead to
poor behavior. Know the things that help your patient to behave correctly.
For example, give the patient a bath in the morning if they are less
confused and agitated in the morning. A bath during the afternoon or
evening may make this patient angry and resist care completely. Very
often, poor behavior happens while care is being given to a patient or
resident. Try to calm a patient during care. Keep things the same and keep
things simple to prevent poor behavior. Know the best routine for the
person and stick to it.
- Know what
triggers poor behavior and try to keep the person from these triggers. Eliminate all
physical, emotional, environmental, communication and care triggers. Meet
the person's needs so they do NOT react with disturbed behavior.
- Give simple
instructions and repeat instructions if needed.
- Listen to the
patient or resident. Many patients and residents will act out with
poor behavior when they can't make their needs known. Spend time with your
patient. Let them ask you questions. Help them tell you about their
feelings. Help them tell you what they want. Use pictures if needed.
Repeat back to them what you think they said or wanted to make sure you
have really heard and understood them. Be clear and calm when
communicating with these patients.
- Observe your
patients and how they act with others. If another easily annoys a
patient, encourage both patients to go to a different place for an
activity or event.
- Approach a
very confused patient from the side and speak face to face. Speak slowly,
calmly and use simple words. Ask simple 'yes', 'no' questions.
- Keep the
patient care area simple. Keep noise down. Make sure that there
is enough light. Keep schedules and routines the same for people who act
out when things are changed. Limit choices if needed. Some patients and
residents get nervous and frustrated if they have too many choices.
Encourage patients and residents to go to well supervised and structured
activities if they are at risk for poor behavior when things are not
- Keep your
attention on the person and not the task. It is the
person and how they are feeling that is important. If a person gets angry
during an activity of daily living, break the task down into small parts.
Encourage the person to be as independent as possible. Praise the person
for their self care efforts.
activities that meet the patients' and residents' needs and prevents poor
Clocks and a large calendar or poster with the day of the week, the date,
the season and the day's weather often help to orient people to time and
current reality. Other socialization and activity groups, like reality
orientation groups, holiday parties and reminiscence groups are often
Promote relaxation and other things that lower stress. Pet therapy, music
therapy and socialization or exercise groups can lower stress.
- Report all
patient changes to the nurse in charge. If a patient condition or
behavior changes they may be at risk for acting out behaviors. Report all
- Be a team
Follow the patient's behavior management plan of care. Everyone on the
team must be consistent. They must all say and do the same things with the
MANAGE disruptive, unacceptable or dangerous behaviors when they
- Stay calm,
speak softly and show respect. If inappropriate, dangerous or
disruptive behavior occurs, speak to the patient(s) calmly, slowly and
with respect. Have them sit to chat. Sit next to them.
- Stop the task
you are doing.
- Call for help
if you need it.
- Protect all
the residents from injury. Stay far enough away from a person so
that they can't hit you. Try to sit the person down. Put a pillow on your
chest if a person is trying to punch you in the chest. Do NOT fight back.
Do NOT pull away if you are grabbed. Stay calm and talk with the person.
Remove the person(s) from harm if your words and instructions do not stop
the dangerous behavior.
- Meet patient
If a person is making noise, find out if they are hungry, thirsty, wet,
dirty, in pain, too hot, too cold or tired. Meet these needs. Feed the
person that is hungry. Give water to the person who is thirsty, etc.
- Report any
disturbed behavior. What triggered the behavior? What happened? When
time was it? Where did it happen? How long did the poor behavior continue?
Was the behavior mild, moderate or very severe? Who else was involved?
What did you do to stop the behavior? Did it work?
- Wash your
hands before and after each patient contact. Handwashing is
the single most important thing that you can do to prevent the spread of
Standard Precautions procedures.
Caring for patients with Alzheimer’s disease requires skill, patience and a
The nursing assistant is a very important
member of the team’s effort. EVERYONE must follow the plan of care in order to
insure that the patient and family members receive the highest possible quality
of care filled with dignity and respect.
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Copyright © 2010 Alene Burke