Joy A. Glenner
Page 11
agnosia. The loss of ability to recognize familiar things by sight, sound, touch, taste, or smell.
Alzheimer disease. A disease caused by lethal structural damage to the brain including tangles and plaques, with an abnormal beta-amyloid protein present in the plaques. It is always progressive, irreversible, lethal (fatal), and can be diagnosed only by autopsy. This disease causes dementia. It is a “type of dementia” or a “dementing illness.”
ambulation. The act of walking about.
apathy. Lack of feeling and emotion, lack of response or desire to act.
aphasia. A general term for loss of language abilities due to brain damage. Expressive aphasia is the loss of written or spoken language ability. Receptive aphasia is the loss of ability to understand written or spoken language.
aspiration. The act of inhaling. Aspiration pneumonia is caused by inhaled food particles in the lungs. It is a common cause of death in persons with Alzheimer disease, due to improper chewing and swallowing of food.
assessment. An evaluation or measure. In terms of caregiving, an evaluation of a person’s ability to function normally. Ongoing assessment is vital to appropriate care for those with dementia.
assisted living. A long-term care community usually regulated by the state’s Department of Social Services. These facilities provide supervision, personal care, and meals for residents who do not need regular or constant medical care. They are nonmedical and tend to be larger facilities or a portion of a larger retirement community. They are designed for older persons or may be for persons with dementia specifically. Residential care and “board and care” facilities are under the same license.
autopsy. A postmortem (after death) examination performed by a pathologist (a physician who studies the nature of disease) to determine cause of death or the nature of a disease process, such as Alzheimer disease.
behavior problem. A difficult behavior in a person with dementia which is harmful, potentially harmful, or disturbing to the person or others. The basic symptoms (PALMER symptoms) are not behavior problems. Behavior problems are secondary; they occur because of these basic symptoms.
benign forgetfulness. The normal slowing of some mental powers in aging.
beta-amyloid. A type of amyloid (a fibrous body protein deposit). The gene for it is on chromosome 21. A segment of this protein is in the plaques exterior to brain cells of persons with Alzheimer disease.
caregiver. A person directly or indirectly responsible (long-distance caregiving is common now) for some, most, or all of the care of another human being.
catastrophic reaction. A sudden, uncontrolled change for the worse in a person’s behavior. It is common in persons with dementia and can happen for a wide variety of reasons.
chronic condition. A disease or disorder that develops slowly and persists over a long period of time. Alzheimer disease is a chronic condition.
cognition. The process of thinking and learning. All of the PALMER symptoms (the basic symptoms of dementia) involve cognitive abilities. Alzheimer disease causes general loss of cognitive abilities (disability).
delusion. A false belief a person maintains despite provable evidence to the contrary. Delusions are common in dementia.
dementia. A global loss of intellectual functioning or cognition caused by disease or injury to the brain. Dementia is not a normal part of aging. Alzheimer disease is the most common form of dementia.
diagnosis. Identification of a disease or condition through scientific observation and assessment of symptoms using various procedures (for example, lab work, X rays, and personal history).
differential diagnosis. A complex diagnosis based on differentiating symptoms from other conditions with similar symptoms. Alzheimer disease cannot be confirmed except through an autopsy. A thorough differential diagnosis can eliminate other causes of dementia, however, with a 99 percent accuracy rate compared to autopsy results.
disease. Any deviation of normal body function or structure which can be identified by specific symptoms or other characteristic signs. The term disease does not mean a condition is contagious or transmittable to others.
excess disability. The disability a person displays beyond what should be present as a result of the true level of impairment.
fine motor skills. The ability to use muscles in the body in small, precise movements (for example, using fingers, wrist, hand, and arm movements to write or draw).
formulary. A listing of medications available at a pharmacy or through a health care plan and from which physicians can prescribe. Many health plans will cover only generic drugs listed in the formulary.
hallucination. A persistent sensory perception—something a person sees, hears, smells, or feels in the external world when nothing is really there.
hippocampus. A small area deep in the brain, at the base of the cerebrum, which is responsible for memory and learning. It is the first area of the brain affected in Alzheimer disease.
hospice. Medically supervised end-of-life care. Its goal is to make the person as comfortable as possible, without treatments to try to cure or prolong life. Hospice support is available to families as well. It is available in almost all residential long-term care settings and at home.
hypertonia. Increased muscle resistance to bending or stretching, causing stiffness and rigidity.
incontinence. The loss of bowel and/or bladder control due to physical problems or to an inability to perceive the body’s signals correctly. It is common in moderate and severe Alzheimer disease.
Instrumental Activities of Daily Living (IADLs). Necessary tasks of daily life (shopping, preparing meals, housecleaning, doing laundry, managing money, using transportation, using the telephone, taking medication) which are not as crucial to independent living as ADLs. They also vary widely in methods of implementation (ways of doing them).
large motor skills. The ability to use muscles of the body in wide, expansive movements (for example, using the muscles of the legs and arms to dance, walk, or lift).
long-term care. Professional care provided on a regular basis for a long period of time. There are many long-term care options, including, among others, home companion and nursing care, social and adult day health care, residential and assisted living, nursing homes, and hospice services. Specialized dementiaspecific care is available in all types of long-term care settings.
mild cognitive impairment (MCI). Mild damage to the brain resulting in some loss of intellectual functioning.
passive aging. Inactivity (physically, mentally, or socially) due to an inability or lack of desire to adapt well to the normal aging process.
pathology. The branch of medicine which explores or determines the nature of a disease by examining tissue and organs to determine structural and functional changes.
perception. The registration in the brain of sensory stimulation—things seen, felt or touched, heard, tasted, or smelled.
perseveration. The tendency of persons with dementia to repeat the same actions, sounds, or words over and over. It can be a severe behavioral problem, but therapeutic activities consisting of one or two simple steps use the tendency to perseverate to good advantage.
positive interaction techniques. Appropriate, positive verbal and nonverbal communication methods that work best with persons with dementia to maintain a positive emotional climate and positive working relationship.
reengage. To reorient someone to a task when he or she appears to be losing interest or to have forgotten what he or she is doing. A person with dementia requires this assistance due to the short attention span.
residential care facility. A small long-term care community (also called a “board and care”) usually regulated by a state’s Department of Social Services Community Care Licensing division. It is nonmedical and is not required to have nurses or a resident physician. It tends to be ten beds or fewer and a private home or intended to be homelike. Some facilities are specifically for younger residents, older residents, or those with dementia. Assist
ed living facilities tend to be larger but are under the same license in most states.
senility. An inappropriate, outdated term referring to the slow deterioration of mental functions during the aging process. It was used to mean forgetfulness in aging believed to be normal. Severe forgetfulness is not normal.
sensory. Of the basic senses—visual, auditory (hearing), tactile (touch or feeling), olfactory (smell), and taste. Sensory stimulation refers to actions or activities that make use of the basic senses in some way. Even persons with very severe dementia retain some use of the basic senses.
skilled nursing. A long-term care community licensed by a state’s Department of Health Services. It is for those who need constant medical care and supervision. Licensed nurses, certified nurse assistants (CNAs), and a resident physician are required by licensing. There are skilled nursing facilities specifically for persons with dementia, and many have dementia care units.
step. A simple message or action complete in itself, one that does not require remembering other steps to understand and complete it. Most persons with dementia need instructions divided into individual, easy-to-understand components, or steps. For example, “pick up the book” is a one-step instruction. “Pick up the book and open it to page 5” is a two-step instruction and would be difficult for many people with dementia.
sundowning. Confusion, restlessness, lack of concentration, and irritability common in persons with dementia toward the end of the day. The cause is not known, but it happens, at least in part, because the person is “overloaded” and extremely tired by the end of a long day due to reduced cognitive functioning.
therapeutic. Beneficial or healing, designed to maximize a person’s self-esteem.
therapeutic activity. An activity designed to maximize a person’s everyday functioning (including but not limited to ADLs and IADLs) and feeling of well-being. It should feel purposeful to the person and should be designed to increase his or her self-esteem.
therapeutic program. A total plan of care based on assessment of a person’s level of functioning. It is designed to reduce excess disability, difficult behaviors, and other secondary symptoms of dementia.
ventricles. The two central areas of the brain which contain cerebrospinal fluid.
Resources
The Alzheimer’s Association provides dementia-specific referrals, support groups, volunteer respite, caregiving training, and support (phone: 800-272-3900; national Web site: www.alz.org).
The Alzheimer’s Disease Education and Referral (ADEAR) Center is a service of the National Institute of Aging (NIH) and is an invaluable source of nationwide information (phone: 800-438-4380; email: adear@alzheimers.org; Web site: www.alzheimers.org).
The National Institute on Aging, Alzheimer’s Disease Education and Referral (ADEAR), is a good source of information on finding reputable clinics, among other things (phone: 800-438-4300).
Perspectives: A Newsletter for Individuals with Alzheimer’s Disease (phone: 858-622-5800).
Index
acetylcholine, 15, 121
Activities of Daily Living (ADLs), 81, 121
body mechanics, 60–68
difficulty with, 8, 27–28, 44, 49, 71
Instrumental, 8, 104–110, 124
managing, 38–42, 44–45, 53, 81, 88, 102–103
safety for, 69–80
specific, 84–100
activity(ies), 101–120
daily flow, 39, 85–86, 110–112
daily requirements, 103–110
enjoyable interactive, 103, 112–120
equipment, 117–119
one- vs. two-step, 112, 115–116
therapeutic, 53, 101–102, 127
unable to stop, 8, 41, 44, 54, 113, 125
Advance Health Care Directives, 24–25
affection, 38, 41–42, 103
aging: active vs. passive, 121, 125
normal brain features, 11, 13–14
agnosia, 4, 121
alarms, for safety, 74, 79
alcohol consumption, 13, 70, 74, 95
Alzheimer disease (AD), 121–122
CAT scan, 13–14
dementia stages, 3, 7–9
diagnosis of, 3, 12, 14–15, 123
as disability, 42–43, 123
early signs, 1–3, 18
pathology of, 10–11, 125
prevention of, 15–16
similar illnesses, 11–13
statistics on, 10–11, 15
treatment of, 15–16
understanding/accepting, 3–7, 16–19, 35
Alzheimer’s Association, 15, 32, 55, 129
Alzheimer’s Disease Education and Referral (ADEAR) Center, 15, 23, 29, 129
ambulation, 8, 51, 122
safety for, 62–65, 67–68, 72
anger, 6, 36, 53
anxiety, 6, 8, 17, 44, 46–49
with activities, 87, 89–90, 110, 112
apathy, 8, 12, 44, 122
aphasia, 5, 8, 122
Aricept (donepezil), 16
aspiration, 8, 122
assessment, 42, 88, 92, 122
diary of, 18, 82, 102
assisted living, 28, 122
assistive devices for walking, 64–65, 68
attention span, 5–6, 8, 36, 39, 118
attorneys, 24–25, 29–31, 33
autopsy, 15, 122
balance, loss of, 68, 70, 73–74
bathing, 87, 89–90
goals, 88, 94–97
problems, 8, 27–28, 44, 49, 51, 71, 81, 89
bathroom safety, 88–92, 95
falls, 70–75, 78–79
infections, 68–69
behavior problems: common, 43–44
managing, 3, 35, 42–55, 102
understanding, 3, 17, 42–45, 122
beta-amyloid protein, 10–11, 16, 123
blood thinners, 16
body alignment, 61–62, 65–67
body language, 36–38, 40–41
body mechanics, 60–68
bowel movements, 50, 94–97
brain aging, normal, 11, 13–14
brain damage: global, 1, 3, 10, 123
gray matter, 10–11, 13–14
car safety, 53–54, 79, 109
caregiver(s), 123
acceptance by, 16–19
safety for, 47, 60–65, 67
stress management, 20–21, 59
support systems, 21–28, 30, 32, 37, 47, 55, 104, 122, 124, 126
caregiving: body mechanics for, 62–68
options for, 7, 9, 19
supplies, 64–65, 68, 77, 95–96
CAT scan, 13–14
catastrophic reactions, 5, 35, 123
managing, 53, 55–59
chair safety, 64–65, 73, 75, 95
chewing, 84–86
child-proof latches, 74, 92, 96
choking, 8, 85, 96
cholinesterase inhibitors, 15–16
cognition, 6–7, 123
activities for, 103–104, 115–117
loss of, 1–3, 12, 15, 123, 125
communication, 35–59
effective strategies, 17–19, 36, 41–42, 63, 125
of instructions, 37, 39–40, 82, 87, 126
nonverbal vs. verbal, 18, 36–37, 40–42
confusion, 8, 44, 70
managing, 38–41, 85–86, 99
conservatorships, 25, 30
cues, communication, 18, 36–37, 40–41, 52, 54
for ADLs, 95, 99
day care, adult, 7, 9, 26, 28, 32, 104
decisions: in daily life, 39, 85–86, 103
long-term care, 21, 24–25
participation in, 22–24
delusions, 8, 42, 52, 123
dementia: stages, 3, 7–9
types, 10–14
understanding, 3–7, 35, 123
demonstration of activities, 117–119
denial, 3, 17–18
depression, 8, 12–13, 36, 44
diagnosis: need for comprehensive, 18–19
&nbs
p; obtaining, 3, 12, 14–15, 123
telling others, 17, 22
diary of assessment, 18, 82, 102
differential diagnosis, 12, 15, 123
dignity, 87, 89–90, 93–94, 98
disability, 42–43, 123
excess, 40, 53, 82–83, 88, 102, 124
disorientation, 8, 54–55
distractions, 42, 89–90
dressing: approaches, 95–97, 99
problems, 39, 44, 81, 98–100
driving, 53–54, 109
Durable Power of Attorney: for asset management, 30
for finances, 25
for health care, 24–25
electrical safety, 71, 73–77, 79
embarrassment, 38, 43, 53, 94, 98
during ADLs, 88, 92, 96
emergency plan/supplies, 77
emotional activities, daily, 6, 103
environment: behavior problems and, 47–48
positive, 37–38
safety assessment, 63, 65, 67–68, 71–80, 99
Excelon (rivastigmine), 16
excess disability, 40, 53, 82, 124
avoiding, 82–83, 88, 102
exercising, 104, 116, 119
expectations, behavior and, 53, 82–83
facial expression, 36, 40–41
falls: prevention of, 68, 72–78, 99
risk assessment, 70–72, 74
family: relationships, 16, 18–19, 104, 111, 116
as support system, 22–23, 27, 47, 55, 104
fatigue, 70, 73
financial planning, 21, 25–26, 29–34
fine motor skills, 103, 124
activity for, 103, 107–108, 113, 115, 117
fire safety, 76, 78
fluid intake, 84–85, 87, 95–96
food preparation, 104–105, 107–108, 113, 118–120
safety, 69, 86. See also nutrition
forgetfulness, benign, 1–2, 122
friends, as support system, 22–23, 47, 55, 104
frustration, 40–41, 53, 99
functionality, behavioral, 44, 102
activity for, 36, 101–102