The abilities of someone with Alzheimer's can fluctuate from day to day, or even hour to hour, which makes the caregiver's job all the more difficult. Often, the person's abilities wax and wane for the same reasons that a healthy person's abilities fluctuate: fatigue, anxiety, discomfort, or medications. Other illnesses may also play a role.
Equally confusing may be a seeming inconsistency in an individual's abilities. He or she may be able to perform a complex task, but not a simple one. Family members may suspect the person is not trying hard enough or is being deliberately uncooperative when, in fact, the uneven loss of abilities is explained by the disease process itself.
Some techniques can improve the quality of life for both patient and caregiver (see "Practical advice for coping with daily routines"). For example, by breaking an activity into simple steps and talking the person through it one step at a time, you can turn a complicated task such as getting dressed into a manageable one.
Approximately 70% of people with Alzheimer's disease live at home, rather than at a long-term care facility.
Decisions about Driving
One of the first questions many families ask is whether people with Alzheimer's disease should stop driving immediately. If the person is only mildly impaired, the answer may not be simple. Some advocates for the elderly believe that driving privileges should not be taken away until a person becomes an unsafe driver. The problem is trying to determine when a person is unsafe before an accident occurs.
Driving requires a complex interaction of eyes, brain, and muscles, as well as the ability to solve problems quickly. A person may appear to drive well until an unexpected situation occurs. The complicated stops, starts, and zigzags of city traffic can cause someone with Alzheimer's to panic or freeze with indecision. A University of California study found that the driving skills of people with mild Alzheimer's were significantly poorer than those of other elderly people, including those with some other forms of dementia.
The person's general behavior in other situations should alert the family as to when safety behind the wheel is questionable. Individuals who exhibit poor judgment, inattentiveness to what's going on around them, clumsiness, and slow or inappropriate reactions certainly should not drive. A tactful approach that preserves the person's self-esteem may work. Some people agree to stop driving if another reason is given — for instance, the car needs repair or the license or registration has expired.
People with Alzheimer's disease sometimes take seriously a written prescription from a physician that says, "Do not drive." If all this fails, you may need to seek advice from a lawyer or an official with the Department of Public Safety in your state. Procedures vary, but generally, a driver's license can be suspended on the basis of a physician's written statement. If nothing else works, you can sell the car.
Practical Advice for Coping with Daily Routines
Use simple phrasing and short sentences, but be careful to avoid talking to the person as if he or she were a child.
To get the person's attention, begin by using his or her name.
Be patient. Give someone with Alzheimer's time to complete a sentence or thought, and try not to interrupt.
Follow the person's old routines as much as possible.
Prepare everything in advance. Lay out towels, soap, shampoo, and clothes. Have the water ready and at the right temperature before bringing him or her into the bathroom.
Avoid discussing whether a bath is needed. If the person refuses to get into the tub or shower, be flexible and suggest an alternative. If all else fails, try again later.
Be calm, gentle, and reassuring. If the person seems disturbed at this invasion of privacy, cover portions of his or her body with a towel.
Encourage him or her to do as much as possible without hands-on help. Talk through each step.
Check the skin for rashes and sores. Use powder or cornstarch to prevent chafing and body lotion on dry skin.
Safety tips: Use rubber tub mats, tub seats, grab bars, nonslip bathmats, etc. Do not use bath oil or products that make the tub slippery. Put razors and electrical appliances out of reach. Take the lock off the bathroom door.