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How to Know it May be Time for Hospice

Watching someone you love suffer from Alzheimer’s or another memory debilitating illness is incredibly difficult, and it can be even more challenging to decide when it’s time to consider hospice care. Our latest video discusses the following five signs that indicate it may be time for hospice for an Alzheimer’s patient.

1. Physician determines they are at or beyond stage 7 of the Functional Assessment Staging Scale

The Functional Assessment Staging (FAST) Scale is a tool used to determine if changes in a patient’s condition are related to Alzheimer’s disease or another condition. If due to Alzheimer’s, the changes will occur in sequential order. Alzheimer’s disease-related changes do not skip FAST stages.  

2. Unable to ambulate independently

This means a person is no longer able to get around on their own. For example, they require assistance getting from room to room.

3. Requires assistance to dress or bathe

Without assistance, you may notice they put their shoes on the wrong feet or their day-time ‘street’ clothes on over their pajamas. They are also unable to bathe without assistance.

4. Becomes incontinent

This includes urinary or fecal incontinence or both.

5. Unable to speak or communicate

This may begin as the patient only saying 5-6 words per day and gradually reduce to only speaking one word clearly until they can no longer speak or communicate at all. This will also include the inability to smile.

Why Choose Hospice

Hospice care is for patients with a life limiting illness and a life expectancy of six months or less. The main focus is to manage pain and symptoms and ultimately keep the patient comfortable. When you choose hospice for your loved one, their care team can help you to understand what to expect in the final stages of Alzheimer’s. They will also provide support to you and the rest of your family throughout the end-of-life process.

If you would like more information on hospice care for Alzheimer’s patients, please contact us. We are here to answer any questions you may have.

Changes in Communication

As Alzheimer’s and Brain Awareness Month continues, we want to discuss a very important topic- communication and Alzheimer’s. As the disease progresses, a person’s ability to communicate gradually diminishes. Changes in communication vary from person to person, but there are several common issues you can expect to see, including difficulty finding the right words and organizing words logically.

Effective Communication

If someone you love is living with the disease, you know it can be challenging at times to communicate with them. The video above discusses the following ten tips for effectively communicating with your loved one.

  1. Never argue. Instead, listen.
  2. Never reason. Instead, divert.
  3. Never shame. Instead, distract.
  4. Never lecture. Instead, reassure.
  5. Never say ‘remember.’ Instead, reminisce.
  6. Never say ‘you can’t.’ Instead, remind them what they can do.
  7. Never say ‘I told you.’ Instead, just repeat.
  8. Never demand. Instead, just ask.
  9. Never condescend. Instead, encourage.
  10. Never force. Instead, reinforce.

Help Make Communication Easier

In addition to these tips, there are steps you can take to help make communication easier, including:

  • Making eye contact and calling the person by name
  • Being aware of things like your tone, how loud your voice is, how you look at them, and your body language
  • Encouraging two-way conversation for as long as possible
  • Using other methods, such as gently touching
  • Distracting the person if communication creates problems

You also want to encourage the person to communicate with you. You can do this by doing things like holding their hand while you talk and showing a warm, loving manner. It is also important to be patient with angry outbursts and remember that it is just the illness talking.

If The Person is Aware of Memory Loss

Since the disease is being diagnosed at earlier stages, many people are aware of how it is impacting their memory. This can make communication even more sensitive because they may become frustrated when they are aware of the memory loss. Here are some tips for how to help someone who knows they have memory problems.

  • Take time to listen. They may want to talk about the changes they are noticing
  • Be as sensitive as you can and try to understand it is a struggle for them to communicate. Don’t correct them every time they forget something or say something odd
  • Be patient when they have a difficult time finding the right words
  • Find a balance between helping them find the right words and putting words in their mouth
  • Be aware of nonverbal communication. As they lose the ability to speak clearly, they may rely on other ways to communicate their thoughts and feelings

Additional Resources

For more information on Alzheimer’s disease and how it impacts communication, visit the links or reach out to the contacts below:

Dear Caregiver,

If you are caring for a loved one who is living with Alzheimer’s disease, you do not need us to tell you that it’s not easy. This progressive disease is difficult to cope with – for both the person living with it and their loved ones. People living with Alzheimer’s may become frustrated when they find themselves struggling to do things they used to do without any problem. And it is hard for you, as the caregiver, to watch the person they once were gradually fade away. They may have brief moments of clarity where it feels like they are themselves again; only to break your heart when the moment is gone. 

While there is nothing anyone can do or say to “fix” what you and your loved one are going through, we want you to know you do not have to face it alone. The Alzheimer’s Association has an abundance of resources for both those living with Alzheimer’s and their caregivers. There are support and educational programs available for both, as well. Take advantage of these resources. They are there to help make things a little easier.

Understanding Alzheimer’s Disease

It all starts with gaining a better understanding of the disease and how it progresses. Alzheimer’s leads to nerve cell death and tissue loss throughout the brain. This results in the brain shrinking dramatically over time which impacts nearly all its functions. 

Although scientists are not completely certain what causes cell death and tissue loss in a brain affected by Alzheimer’s, plaques and tangles appear to be the culprits. Plaques form when protein pieces called beta-amyloid clump together, and tangles destroy a vital cell transport system made up of proteins. Plaques and tangles tend to spread through the cortex in a predictable pattern as Alzheimer’s disease progresses, but the rate of progression varies greatly.

Early Stage

In the earliest stages, plaques and tangles begin to form in brain areas involved in learning and memory, as well as thinking and planning. In this stage, a person can still function independently but may start to notice they are sometimes forgetting familiar words or where to find everyday objects.

Someone in this stage may struggle to:

  • Think of the right word or name for something
  • Remember the name of someone they just met
  • Remember something they just read
  • Plan or organize things

Middle Stage

In the middle stage, more plaques and tangles develop in the regions of the brain important for memory, thinking, and planning. This leads to the development of problems with memory or thinking that are severe enough to interfere with work or social life. In this stage, someone with Alzheimer’s may have trouble handling money, expressing themselves, and organizing their thoughts. Plaques and tangles also spread to areas involved in speaking and understanding speech and the sense of where your body is in relation to objects around you. It is in this stage that many people are first diagnosed.

Symptoms vary from person to person, but may include:

  • Forgetting events or personal history
  • Feeling moody or withdrawn
  • Being unable to recall personal information such as their address
  • Confusion about what day it is or where they are

Late Stage

Most of the cortex is seriously damaged by the time someone reaches the late stage of Alzheimer’s disease. By this point, the brain shrinks dramatically due to widespread cell death. Individuals often lose their ability to communicate, recognize family and loved ones, and to care for themselves in this stage.

In this stage, symptoms are severe and may include:

  • Need for around-the-clock personal care
  • Loss of awareness of recent experiences and their surroundings
  • Changes in physical abilities such as walking and eventually swallowing
  • Difficulty communicating
  • Vulnerability to infections, especially pneumonia

Resources for Each Stage

The Alzheimer’s Association provides excellent resources for caregivers for each stage. Visit the links below to learn more.

Yours truly,

Apreva Hospice

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