Jaimie E, I've learned a lot reading your posts since you joined the Care Consultant board. Maybe you and others can help me with this issue. My LO just moved from apt in one state to apt in a continuing care facility in my state. She is not adjusting well and perhaps I erred in selecting indep living to start instead of going to assisted living. I think my LO is probably progressing, or has progressed, from mild-to-moderate to moderate stage. My LO's personal history probably involves chronic unacknowledged, untreated depression. This problem I think is affecting significantly my LO's ability to function. LO's personality manifests itself as extreme negativity, apathy, sleeping lots and insomnia. LO is barely tolerating hired caregivers on hand to help orient her to new place, refuses offers to go places or participate in activities or go to dining room to eat or retrieve food. There is upcoming appt with new primary care physician, which will be preceded by 1.5 hour session with the practice's social worker, for testing I assume (which will make LO very angry I predict). My question is where can I educate myself about effective strategies for treating depression in dementia patients so I know what to ask for from doctor? Also, where can I learn the names and locations of residential facilities that implement "best practices" in caring for residents with behavioral problems? I would move my LO to one of these I am so worried about the situation going forward. My LO is verbally but not physically aggressive and this combined with the depression and negativity and rejection of assistance is making our efforts at residential support difficult and I forsee problems getting LO transitioned to assisted living when the time comes. Thanks for any info or shared experiences.

Dear Betty_B,

I am glad to hear you are learning from the message board, I hope you can continue to find the information and support you need in our community.

The decision to move your loved one is probably one of the most commonly questioned decisions. The feeling of doubt is only exacerbated by the behavior of the person with Alzheimer’s. When persons with Alzheimer’s are placed in new environments they often show new symptoms and evidence of decline, some believe this is due to the loss of stability which they may have had in their previous living situation. However, it often takes time and a strict routine for a person with Alzheimer’s to become stable again. You may want to try to work with the staff at the facility to make a schedule that works for your Mom that resembles what she did at her previous residence.

To find more about care facilities in your area go to http://www.alz.org/we_can_help_senior_housing_finder.asp. Often caregivers find the best way to learn how a facility handles behavioral problems, is to visit the facility and ask the “right” questions. Go to Carefinder at http://www.alz.org/carefinder/index.asp and under ‘Care Options’ click on the link ‘Questions to Ask’ to learn more about what you may want to ask a facility or care provider. Some facilities that have dementia care units have staff trained to handle specific dementia related behaviors. Caregivers often ask the administrators of the facility what training the staff goes through to know how to best handle behavioral situations.

Aggression, verbally and physically, is very common in the mid to later stages of Alzheimer’s disease. This can be very difficult to deal with emotionally and otherwise. Often caregivers find that there is usually a reason behind the aggression. Your Mom's aggressive reactions may be a result of her confusion and fear. Try to talk in simple, concrete ways to your Mom so to not confuse her, which may be the root of her aggression. However, as you mentioned she has a history of untreated depression, and as in any population with depression, a symptom is often irritability and agitation. Depression is very common in persons with Alzheimer’s in the early to mid stages. One option to get to know more about depression in persons with dementia is to consult a geropsychiatrist, or a psychiatrist that specializes in the treatment of mental health disorders and Alzheimer’s. When it comes to Alzheimer’s disease it is hard to detect what is a symptom of Alzheimer’s and what is psychiatric. One symptom of Alzheimer’s is the inability to initiate activities; the person may not be very active because they no longer know how to start an activity. This same behavior could be seen in a person with depression. Because of this complication it is best to consult your physician or a specialist, for diagnosis and pharmaceutical treatment options.

For more information about Depression and Alzheimer’s visit http://www.alz.org/living_with_alzheimers_depression.asp

Here are some general non pharmaceutical tips to supporting your Mom. Schedule a predictable daily routine, taking advantage of your Mom’s best time of day to undertake difficult tasks, such as bathing; make a list of activities, people, or places that the person enjoys now and schedule these things more frequently; help your Mom exercise regularly, particularly in the morning; acknowledge the your Mom’s frustration or sadness, while continuing to express hope that she will feel better soon; celebrate small successes and occasions; find ways that your Mom can contribute to family life and be sure to recognize her contributions. At the same time, provide reassurance that she is loved, respected, and appreciated as part of the family, and not just for what she can do now; nurture her with offers of favorite foods or soothing or inspirational activities; reassure the person that she will not be abandoned.

In many, if not all, of the stages of Alzheimer’s disease caregivers find moving their loved one as very difficult. When the times come for your Mom to receive more care one important tip to remember is to find stability by providing structure. Each transition will most likely be difficult, but you seem to be doing your best to plan ahead which is a very wise move to take. Currently your Mom may need more time to adjust to her new routine.

If you have any questions or concerns and you would like to speak with a Care Consultant directly contact our helpline at 800.272.3900 anytime day or night.

Sincerely,

Jaimie E.

Alzheimer’s Association
Care Consultant

Jaimie E., Thank you for the very informative and comprehensive post. I will follow up on your suggestions. Thanks again. Betty