Patterns of progression in Alzheimer’s disease, Part 6

One of the questions I am frequently asked by families and staff caring for people with Alzheimer’s disease is how to better understand the patterns of progression during the slow deterioration of the brain. This blog entry is a continuation of excerpts from my book, Alzheimer’s Basic Caregiving – an ABC Guide, as guidance on that topic. To order the book, click here.

The primary motivation of people in Stage 6 is comfort. In terms of dress, people in Stage 6 are seldom interested in keeping up appearances. If you've ever come home from a night of partying or from work after a long day of "looking professional" and the first thing you do is take off your jewelry, your belt and your shoes, you have an idea of how a person in stage 6 is likely to react to being “gussied up.” Comfort for a person in stage 6 can also extend to removing eyeglasses, dentures and hearing aides, and that requires vigilance. I know of one nursing home resident who, as she finished toileting, scratched her ear, felt the hearing aid, took it off and looked at it, and before anyone realized what was happening, flushed it down the toilet. When questioned about what she had done, she said, "I threw that turd away." Many share the sentiment.

Pay attention to the fact that seeking comfort may be based on experiencing real discomfort. Glasses may be dirty or the prescription may no longer be appropriate. Dentures may not fit well anymore or they may have food particles caught beneath them. Hearing aids may be hard for the person to adjust or may not seem to help. Pay attention to the message behind the behavior because by this time, a person’s ability to verbally express the cause of his discomfort is long gone.

If you haven’t done so before, Stage 6 is the time to simplify. People in Stage 6 often resist changing clothes, probably for a number of logical reasons:

• Their ability to dress themselves independently has disappeared, and left to their own devices, they may put pants on backwards, shoes on the wrong feet or underwear over pants.
• They may have some awareness of their difficulties; therefore, once they are dressed, they see no reason to change clothes, and may find even the thought exhausting.
• They may also find the process literally painful as physical changes make them less flexible or chronic conditions such as arthritis intensify.
• They may find the ordinary clothes they wore in the past challenging. Stage 6 is when clothes that pull on, pull over, slip on, fit loosely, feel soft, zip rather than button and tighten with Velcro rather than shoestrings, are all appropriate.

Next up: More middle stage changes in AD