Stages of Alzheimers Disease

Although the course of the disease is unpredictable, it has been observed that the symptoms tend to fall into three stages that often overlap.

STAGE 1:  DURATION -  2 – 4 YEARS

COMMON SYMPTOMS  INCLUDE:

• Short term memory loss
• Difficulty in concentrating
• Poor judgment
• Hesitancy about doing things that once came easily
• Sometimes problems with finding the right expression or word
• Often withdrawn
• Some perceptible changes may occur in personality
• Anxiety about not being able to remember as well
• Anxiety about what is happening to him/her
• Difficulty coming to decisions

STAGE 2:  DURATION - 2 – 10 YEARS FOLLOWING DIAGNOSIS

COMMON SYMPTOMS INCLUDE:

• Repeating statements
• Real difficulty remembering friends’ and family members’ names
• Restlessness, especially at night and late afternoon (called “sundowning”)
• Fear of getting into the bathtub
• Real difficulty dressing
• Perceptual-motor problems
• Increased difficulty organizing thoughts
• Problems with reading, working with numbers and writing
• More and more difficulty locating the right word
• Suspiciousness, sometimes irritability
• Hearing or seeing things that aren’t there in fact

STAGE 3:  DURATION - TERMINAL PHASE

COMMON SYMPTOMS INCLUDE:

• Doesn’t recognize him- or herself
• Unable to take care of him- or herself
• Difficulty swallowing
• Sleeps longer and more fitfully
• Bizarre or disturbing behaviors such as constant crying, hitting, biting, screaming, grunting noises
• Loss of control over bladder and/or bowels
• Abusive, angry, aggressive, demanding behaviors
• Bizarre sexual behaviors

Senior Care and Heart Failure

Heart Failure is also known as Congestive Heart Failure. Many seniors eventually suffer from this disorder as they age.  It is a chronic condition but manageable and affects nearly 6 million persons.

The following suggestions will help the senior to stay well and out of the hospital.  These can be called “RED FLAGS’. Keep this list on your refrigerator.

1. Watch for signs that your condition may be getting worse. These include weight gain, swelling in the legs and ankles, swelling in the abdomen and an unexpected weight loss.  All of these together or separately should be told to your doctor.
2. Watches for shortness of breathe on exertion, climbing steps and doing light exercise. Again this will be a noted change and should be reported to your doctor.
3. Don’ smoke. Quit if you do. Ask your doctor to help you and or join a “quit smoking program”.
4. Do exercise daily.  Walking a half hour daily at a pace comfortable for you will be helpful. Always check with your doctor prior to staring an exercise program.
5. Limit your alcohol intake to a drink per day. Not 8 ounces per drink-more like 3-4 ounces.
6. Reduce your intake of salt and water.  Ask your doctor what your limits are and stick to them. It is helpful not to cook with salt and leave it off your table. Use Mrs. Dash instead. Remember all changes take time to get used to so don’t give up if your taste buds talk to you and say NO at the change.
7. Ask your doctor what your salt intake is for daily use. Remember that all canned foods, process meats are higher in salt (sodium). Fresh vegetables and frozen are much lower in salt content. Cook turkey and chicken to use as meats for sandwiches. Soups canned are high in salt. Begin to get used to looking at the label to see the sodium content. The higher the number the worse the product is for you.
8. Take your medicines as prescribed by your physician. Do not change their times nor dosage on your own just because you are feeling better. You are feeling better because of your lifestyle changes and your medications. Do not SKIP DOSAGES. If your routine is working don’t change it on your own.
9. Keep regular contact with you doctor and keep all appointments. Do all the tests and blood work required by your physician, A cardiologist may be helpful to see.
10. Visit hopkinsmedicine.org/healthseminars on the internet for more information.
11. Keep yourself abreast of information on the internet but always ask your physician what he thinks about the information.

Elder Care and In Home Care

Sandy, Power of Attorney for Mary, contacted Ivory House Care Management in February 2007.  Mary, at age 88 years, had sustained a very large stroke and was hospitalized at an acute rehabilitation center for the brain injured.  She was paralyzed on her left side, had difficulty swallowing and was incontinent.  Her diabetes and hypertension also presented complications.  Mary’s long term prognosis was poor.  Her physician had told Sandy that she would be lucky to live six months.

Since she had never married, Mary had no close family to care for her.  Other than her nephew in Virginia, she had two close friends, Sandy and Clara, who shared responsibilities as Power of Attorney. Also there was Wilbur, a handy man who lived on her property.  None of her friends had senior care experience.  When the rehabilitation center notified Sandy and Clara that Mary was ready to be discharged, they contacted Ivory House about assisted living care.  Mary wanted in home care to be with her cats and friends.

Prior to Mary’s discharge, a geriatric care manager from Ivory House went to visit and reviewed her medical history and progress at the center.  She met with the social worker and arrangements were made to have medical equipment and a hospital bed delivered to Mary’s in home care even before she left the center.  The geriatric care manager also met with Sandy to review the assisted living care for Mary and discuss several elder care services.  Round-the-clock in home health care services were provided.

Pam was the aide from Ivory House who cared for Mary from 7 A.M. to 3 P.M.  She and Mary developed a close relationship.  Every day Pam would make Mary’s favorite breakfast which included eggs, bacon and fried tomatoes.  After breakfast she would bathe and dress Mary and get her up in her chair to watch the “Price is Right” or Animal Planet.  Pam also monitored Mary’s blood sugars, blood pressure, level of awareness and general well being.  If there were changes, she would immediately call the care manager at Ivory House and have her assess the situation.

Because Mary was incontinent and wore diapers, skin care was especially important.  Mary’s senior care manager would visit every 1-2 weeks to assess her skin and general condition.  She would then discuss with Pam the best approach to maintaining Mary’s skin.  This helped prevent skin breakdown and ulcers from occurring.

After several weeks at home, Mary’s physical condition continued to improve.  With exercise and good nutrition Mary was able to go visit the hairdresser and antique business located on her property.  By summertime she was strong enough to take short excursions with Pam to the grocery store, farmer’s market and fruit farm in Pennsylvania.  Eventually Mary became a “fixture” again at the antique shop and made flower arrangements with Pam during the Christmas holidays.

In September 2008, Mary had her 90^th birthday.  Sandy and Clara helped Mary arrange a reception at the L’Hirondelle Club which included Mary’s favorite foods, drinks and a dance band.  Pam took Mary shopping at Nordstrom’s for a new silk suit and “strappy” sandals.  Although she was wheelchair bound, Mary wanted to look her best for this event.

January 2009 Mary suffered a second massive stroke.  After 3 days in the hospital she came home on hospice care.  Over the next week family and friends came to visit and say goodbye.  Mary died quietly in her sleep and all agreed that she had lived the last two years, as a gift, with quality.