Alzheimer’s Care in the Nursing Home

Alzheimer’s disease is a slowly progressive, degenerative disorder of the brain that eventually results in diminished brain function and death; it is the most common form of dementia. Alzheimer’s disease affects 10% of those over age 65 and 50% of those over age 85. The duration of the disease is usually 10-20 years. Those with Alzheimer's disease show memory decline as well as problem behaviors and loss of ability to perform self care. They gradually progress to the point where they can no longer care for themselves, talk, perform any self care, or swallow due to loss of important brain chemicals.

What are the risk factors for Alzheimer’s disease?

Risk factors include increasing age, head injuries, genetic makeup, less than an 8th grade education, Down’s syndrome, a diet low in antioxidants, and estrogen deficiency.

What are the risks for other health problems in those who have Alzheimer’s disease?

The risk for health problems increases as Alzheimer’s disease progresses. Those with end-stage Alzheimer’s disease may sleep a lot, fail to communicate, have poor appetites, and not recognize things or people in their surroundings. Many spend most of their time in a bed or wheelchair and are at high risk for infections, weight loss, and pressure sores.

What medicines are available to treat Alzheimer’s disease?

Drugs such as Aricept, Razadyne, Exelon, and Namenda are commonly used treatments for Alzheimer’s disease. They work in the brain by slowing down the breakdown of important neurotransmitters (chemicals). It is difficult to see the benefit of such drugs, but once they are stopped, patients make a rapid decline; therefore, it is best not to stop the drugs once they are started until the patient is at the end stages of dementia, where little benefit is noted and a decline will not be so apparent if stopped. Side effects of these drugs include diarrhea, nausea, and vomiting and may prevent their full use. Some have also noticed increased agitation with the use of such drugs during the first couple weeks of use while patients’ bodies adjust to the medication. Even with the risk of side effects, these drugs are safer to use than many antipsychotic drugs and may decrease the need for such drugs. Unfortunately, many nursing homes only use antipsychotic medications to treat Alzheimer’s disease and other dementias.

What can I do to help ensure my loved one with Alzheimer’s disease has a good quality of life in the nursing home?

  • Work with your loved one’s doctor to make sure staff understands and respects you and your loved one’s wishes and to set realistic treatment goals.
  • Place familiar objects at bedside such as pictures of loved ones, quilts, and stuffed animals that are recognized easily. Provide familiar music, as well. This may improve care as staff may see your loved one in a different light.
  • Help staff know what your loved one was like before Alzheimer’s disease. Put a picture above the bed with a little story about his or her life, accomplishments, favorite things, hobbies, and so on.
  • Be involved. With the facility’s permission, visit with special foods or a family pet your loved one will enjoy.
  • Help your loved one eat at mealtime.

Questions to ask the nursing home staff members to help ensure they can provide quality care to your loved one with Alzheimer’s disease.

  • What treatments or activities does the nursing home offer that might help my loved one feel better?
  • Are there any medications that might help slow the progress of the Alzheimer’s disease and keep my loved one more alert longer?
  • What treatments, activities, or medications might help my loved one's difficult behavior caused by the Alzheimer’s disease?
  • As my loved one gets sicker, how can end-of-life and hospice care help make sure he or she is comfortable?
  • Many nursing homes have activity programs geared toward patients with dementia. What types of programs do you provide?

Some things to observe in nursing home staff to know that the administration is teaching them how to provide quality care to patients with dementias such as Alzheimer’s disease.

  • Keeps changes in the environment and daily routine to an absolute minimum.
  • Performs personal care at the same time each day.
  • Maintains consistency in caregivers.
  • Keeps consistent meal and medication times.
  • Simplifies routines and reduces choices to minimize feelings of anxiety and frustration.
  • Uses patience and redirection.
  • Keeps verbal requests simple, uses one-step commands and breaks down tasks. For example, not telling the resident to “go to the bathroom,” but guiding the resident to the bathroom and instructing the individual to walk to the toilet, pull down pants, sit on the toilet, and then try to urinate.
  • Ensures the resident has his/her glasses on and working hearing aids if indicated. Makes sure hearing aid batteries are working.

Resources

The Alzheimer’s Association
National Institute on Aging
American Medical Directors Association