Home care for patients with Alzheimer's disease

Have you ever seen the movie "I Miss Myself"? The protagonist Alice Howland is a university psychology professor. When she was fifty years old, Alice found that her memory was getting worse and worse. One day, she suddenly got lost in the place she was most familiar with. From forgetting trivial matters to gradually forgetting her daughter's name and her husband's face, the world in her eyes was constantly changing. Her memory could not keep up with the pace of forgetting. She gradually lost her own thoughts. The doctor's diagnosis completely changed her life. She was diagnosed with Alzheimer's disease (senile dementia). However, with the company and care of her family, she was able to experience the beauty and love in life. Alice Howland was still herself. She bravely lived for every day and for the present, becoming the strongest woman.

Alzheimer's disease is a primary degenerative brain disease with unknown etiology. It has an insidious onset, progressive aggravation, and a slow and irreversible course. It is often manifested by progressive degeneration of memory, understanding, judgment, self-control and other abilities, as well as persistent intellectual impairment, which affects daily life and social skills [1].

Let's take a preliminary look at the symptoms of Alzheimer's disease that Alice Howland experienced in the movie. What are the specific manifestations of Alzheimer's disease? What are the precautions for home care? Let's learn and discuss together.

1. Clinical manifestations of patients

1. The disease has a slow onset and is not easy to attract people's attention: the early symptoms are personality changes. The patient becomes subjective, willful, stubborn, selfish and narrow-minded. He does not like to interact with others, asks the same questions repeatedly, does not greet people, often picks up some waste items and takes them home to pile them up, is no longer willing to visit neighbors, does not greet neighbors when he sees them, always shirks community activities, and often cannot find his keys and cannot get into the house.

2. Lack of affection for family members and emotional instability: easily irritable, sometimes noisy, hitting and scolding family members for no reason, and even unable to take care of themselves. They often collect waste such as paper, cloth strips, and thread spools and keep them as treasures.

3. Impaired judgment of things: Patients are often suspicious and have delusions of being murdered or robbed. They keep doors and windows closed and often hide what they think are valuables under the bed, in socks, or in shoes. If they cannot find them, they assume they have been stolen, and then they lose control of their emotions and speak without thinking.

4. Memory impairment: The decline of recent memory is particularly significant, for example, forgetting what has just been done, forgetting that you have eaten but still ask for a meal, taking medicine again after just taking it, not being able to recognize the way home after going out, not recognizing people you saw a few days ago, not remembering what your family looks like, and even not being able to recognize yourself in front of a mirror. The ability to retain memory is extremely poor, often mixing up clothes, mistaking socks for gloves, and wearing shoes the wrong way. As the disease progresses, long-term memory will also be impaired, forgetting the names of family members and yourself, not remembering the occupations of your children, forgetting some people and things you experienced when you were young, and eventually he (she) will "forget himself".

2. Home Care Guidance

1. The home care environment needs to be adjusted accordingly: according to the daily living habits of the elderly, keep the room clean, the indoor air fresh, and ventilate regularly; the indoor light is bright but not dazzling, and the items are placed in an orderly manner so that the patient can easily identify and put them away [2]; it is recommended that the furniture is simple and the light is sufficient to avoid tripping; the bedroom should preferably have its own bathroom for easy use, the floor should be kept dry, and the walls should have handrails; the bed should not be too high, and a bed block should be added when necessary; the door locks of the toilet or bedroom should be removed to prevent the patient from locking himself in, to ensure safety and reduce injuries.

2. Food safety care: Patients should eat and drink slowly to avoid choking and suffocation; discard spoiled food in time to prevent patients from being unable to distinguish between good and bad food and eating it by mistake; fix drinking cups in places that the elderly are familiar with, such as bedside tables and dining tables, for easy access.

3. Nursing to prevent infection: Alzheimer's disease patients have decreased physical resistance, poor self-care ability, and are not aware of cold or heat. Some elderly people are bedridden for a long time and have reduced activities, which makes them very prone to various infections, such as pneumonia, pressure sores, and urinary tract infections. They should pay more attention to observation, add or remove clothes according to weather changes, turn over and buckle their backs regularly, massage the pressure areas, and use buckwheat hull mattresses or air cushions when necessary to reduce skin friction in the pressure areas and prevent pressure sores. Drink more water to increase urine output to prevent urinary tract infections.

4. Nursing during drug treatment: Administer medication strictly according to the doctor's instructions and watch the patient swallow the medication to prevent the patient from hiding the medication and swallowing a large amount at one time, and closely observe adverse drug reactions.

5. Safekeeping of valuables: Keep wallets, keys, bills, passbooks and other valuable items away to prevent the elderly from taking them away or hiding them. If they forget where they put them and cannot find them, they may lose control of their emotions and worsen their condition.

6. Reduce the risk of going out alone: ​​Sew a label with the name of the elderly person with dementia, the name and contact information of the family caregiver on the collar, or wear a bracelet with identity information on the wrist, so that the elderly person can be found and contacted with family members in time if they get lost, reduce the risk of various accidents caused by getting lost, and try not to let the elderly go out alone. If they have to go out and don't let their family members follow them, you can follow them secretly and take care of them in time if an accident occurs.

7. People-oriented, improve the patience of caregivers, and provide individualized care: Demented elderly people need people-oriented care methods at home. We must believe that demented elderly people can also experience the meaning, comfort and fun of life. Every demented elderly person has their own unique life experience. Their abilities, needs and preferences are different, and they will change with the course of the disease. Therefore, family caregivers should be good at formulating and adjusting care plans according to the specific circumstances of the elderly and provide patient and meticulous care. For example, in the middle stage of dementia, the elderly's memory loss will become worse and more confused. At this time, it is necessary to talk to him in simple and clear sentences, and he can only be arranged to do one thing at a time. When talking to the elderly, he may not understand. Stay patient and calm. When you encounter words he can't understand, point them out to him. Don't argue with him, and don't reason with him. Although dementia gradually deprives them of their cognitive abilities, they still retain emotions and the ability to perceive beautiful things. He (she) will feel the friendliness, respect and consideration of the caregiver from smiles, touches, gentle voices and tones.

8. During the care process, appropriate and detailed cognitive and life skills training should be carried out: a clock with a calendar display should be installed in the room to prompt the patient to confirm the time and date; memory training activities should be carried out, and the songs that the patient used to listen to should be downloaded and played at regular intervals to train the memory; according to the patient's own condition, a suitable time should be chosen to take the patient to a familiar park or square for a walk, to chat about family matters, to recall some people and events that the elderly experienced when they were young, to guide the elderly to talk about interesting things that happened during their time together, and to enhance their cognitive ability; accompany the patient to the supermarket and let the patient choose to buy daily necessities on his own to improve the patient's ability to live independently.

3. Discussion on Home Care

1. Alzheimer's disease is the most common symptom of elderly mental illness [3]. The ideal place to care for patients with dementia is the patient's home. As the disease progresses, the elderly with dementia quickly develop into a state of being unable to take care of themselves, becoming irritable and out of control, which places a great burden and mental pressure on the entire family and caregivers. When a family has a patient with Alzheimer's disease, in a sense, the one who suffers the most is not the patient himself, because as the disease progresses, the patient's world of thought will become simple, entering a state of "selflessness", and he will not feel the bitterness, happiness, sourness and sweetness of life. He only remembers the people and things at the beginning, and he (she) may even "forget himself". The one who suffers the most is actually the family members who take care of them.

2. Through home care guidance, improve family members' understanding of Alzheimer's disease. Encourage family members and friends to spend more time with patients, avoid being indifferent to patients, and create a harmonious family atmosphere and a relaxed and pleasant language communication environment [4-5] to reduce loneliness, let patients feel the warmth of home, delay mental decline, continuously enhance the sense of health, happiness, and security, actively prevent and intervene, let love retain memories, improve the quality of life of patients and the life satisfaction of caregivers, and reduce the burden on caregivers.

3. Compared with other groups that require long-term care, patients with dementia require more personal care, more nursing time, and more health monitoring. They will eventually need to rely entirely on others for care, which will bring a heavy economic burden and great mental pain to their families. my country is currently the country with the largest elderly population in the world. The incidence of dementia patients is on the rise. The most ideal place to care for dementia patients is the patient's home. If the patient can take care of himself, he can live in his own home. However, long-term care by family members will also bring mental stress to family members. Therefore, establishing geriatric hospitals, community health service centers, geriatric psychological counseling and other family-based health care so that the elderly can receive medical treatment locally is a powerful measure to promote the health of the elderly [6].

In short, with the acceleration of the aging process of the population, the incidence of Alzheimer's disease is increasing year by year. Unfortunately, there is no cure for the disease once it is diagnosed. Alzheimer's patients can live for many years after the onset of symptoms. Alzheimer's disease has a long course and the cost of diagnosis, treatment and nursing is high. More than 75% of the families of patients in my country adopt home care. The careful care, nursing and support from the family and society can still make the elderly with dementia live comfortably, safely and happily, improve the health level of Alzheimer's patients, delay the dementia process, retain the quality of life and dignity in old age, and improve the life satisfaction of caregivers.

I hope every elderly person with dementia can have a happy old age.

References

[1] Shen Yu. Psychiatry[M]. 5th edition. Beijing: People's Medical Publishing House, 2023:954-957.

[2] Jiang Yanli. Nursing of emotional disorders in patients with senile dementia [J]. Chinese Journal of Health Standard Management, 2023.6(8):178-179.

[3] Zhang Tao. Nursing status and nursing model of Alzheimer's disease[J]. Chinese Journal of Practical Nursing, 2023, 2.

[4] You Liming, Wu Ying. Internal Medicine Nursing [M]. 5th edition. Beijing: People's Medical Publishing House, 2023:825-837.

[5] Hao Wei, Yu Xin. Psychiatry [M]. 7th edition. Beijing: People's Medical Publishing House. 2023:59-61.

[6] Fang Haiying. Clinical characteristics and nursing strategies of mild cognitive impairment [J]. Chinese Journal of Misdiagnosis, 2023, 8.