Caregiving Questions

So long as your father is enjoying the outings and does not seem to be resistant to later returning to the nursing home, then there really should be no problem with occasionally taking him out for a few hours. In fact, it may actually be very good for him to regularly engage in such excursions, particularly if they have a positive effect on his attitude and behavior. As you said, the outings are something for him to look forward to, and therefore may be beneficial for his overall psychological well-being. Just make sure that the outings are planned in advance and do not greatly disrupt his normal schedule.

Without getting into an argument with your mother and relatives, talk to them and try to understand why they are so resistant to letting you take him out once in a while. For example, does your father become more difficult for them to deal with later that evening or the next day? Does he become anxious beforehand? Or are they just worried that something negative will happen as a result of you taking him out for the afternoon? Whatever the reasoning behind their decision, you can reassure them that in the long run, the benefits of getting him out and socially engaged in other activities far outweigh any short-term disturbances in his behavior. The excursions should be encouraged until at such point he is no longer able to reasonably undertake in them.

When you know you have a long drive ahead, anything you can do to plan ahead and reduce stress may also help to reduce your husband's angry outbursts. Try to plan your trip early in the day when his attitude may be better, and make sure that both of you are well-rested for the journey. Bring along snacks, drinks, puzzles or travel games, books on CD, or music that he enjoys—anything that can serve as a distraction and keep him occupied during the drive. Do not rush your trip—stop often for breaks. For example, even if it takes longer to get there, try stopping at a half-way point for a snack, bathroom break, or even just a chance to get out of the car and stretch your legs. If you are driving back the same day, again make sure that you leave early enough that you will not be arriving home too late in the evening (even if this means cutting your visit short). And by all means, if you sense that your husband is about to have an outburst, pull over to the side of the highway as soon as it is safely possible. Do not continue with your drive until you are able to calm him down again. In these cases, even though it is difficult, try to stay calm and resist the urge to yell back at him, because this will only serve to agitate him more.

It may also be helpful for you to consider joining an Alzheimer's support group. You can search for Alzheimer's caregiver and patient support groups in your area by visiting our "Resources" section, such as under the Caregiving and Caregiver Support heading in "Helpful Organizations."

Based on the details you have provided, your mother would appear to be in early stage 3 of Alzheimer's disease. Your mother's physician can provide you with a definitive answer.

Everything you have mentioned is typical behavior for a patient having Alzheimer's disease or dementia. Disturbances in sleep-wake cycles, sleepwalking, repeatedly asking the same question, asking about long dead family or friends, confusion and forgetting locations, dates, or times are all behaviors commonly found in this disease. Your husband's behavior may at times seem incredible to you—before his diagnosis you might have even thought that he was pulling your leg—but these occurrences, however disturbing, are all a part of the disease process. Just remember that he is not purposely trying to upset or annoy you, and that your continued calm reassurances will be of comfort to him in his confusion.

If you have not already done so, you should consider joining an Alzheimer's support group. You can search for Alzheimer's caregiver and patient support groups in your area by visiting our "Resources" section, such as under the Caregiving and Caregiver Support heading in "Helpful Organizations."

First try to determine if there is reason why your mother is waking up each night. Is her bed uncomfortable to her? Is the room too hot or too cold? Perhaps she wakes up to use the toilet but then cannot find her way back to bed, or the chair she prefers to sleep in is more convenient to the bathroom than the bed. These are all relatively simple fixes in that you can check to make sure her mattress is comfortable, adjust the temperature at night, add or decrease the number of blankets on her bed, make sure there is a clear, unhindered passage to the bathroom, and perhaps even install a small nightlight in or near the bathroom. You can also encourage her to decrease her fluid intake a few hours prior to bedtime, and decrease or remove caffeinated beverages from her diet.

If none of these things seem to help, then someone may just have to spend a few nights with her and calmly redirect her to bed each time she goes to the chair. You could also try stacking pillows and other bulky items on the chair each night to make it is inconvenient for her to sit there—in which case she may find it easier to go back to bed.

While sleep disturbances are not uncommon for Alzheimer's disease patients, you may also consider having her checked out by her primary care physician to make sure there is no other underlying medical condition responsible for her nighttime behavior.

First try speaking to her primary care physician about having her mouth and throat examined. It is possible that she has a sore throat, has sores in her mouth, or else has dental problems that are causing discomfort when she eats and swallows. These issues all need be addressed first before jumping to other conclusions. The doctor can also assess her swallowing ability to determine if she indeed has a medical problem.

However, while taking longer to chew and swallow could be indicative of a swallowing issue, these things could be "normal" for her in that she simply requires more time to do things than she used to. Additionally, sometimes Alzheimer patients temporarily forget how to eat or swallow, or they forget what they are doing right in the middle of doing it. If this is the case, it would not hurt to bring along a small snack and beverage of your own when you go to visit your mother-in-law during mealtimes, so that you can eat with her. These visual aids can help to remind her what it is she is supposed to be doing with her food and drink.

It seems that a second opinion would be very helpful in your mother's case. If your mother does indeed have dementia or Alzheimer's disease, there may be medications that could at least alleviate some of her symptoms. If your parents refuse to find a new physician, you will have to find one for them. You can start by searching for a good geriatric physician specializing in dementia in your parents' area. Try asking for doctor suggestions from other caregivers of Alzheimer's patients in your parents' area, such as through caregiver support groups (which can be found by visiting our "Resources" section, such as under the Caregiving and Caregiver Support heading in "Helpful Organizations"). There are some—though very few—geriatric specialists who still make house calls to their patients. Finding a doctor who could come to your mother would obviously be an immense help.

If a doctors' house call is not a possibility, try at least reasoning with your father about why your mother should get a second opinion from another doctor. Perhaps encouraging your father to go with you to a caregiver support group meeting—where he can discuss health-related concerns with other caregivers—may help in changing his view on medical intervention. Try to understand the reasoning why they are so resistant to going to a new doctor—fear of change, fear that another diagnosis will be even worse, loyalty to their current doctor, etc.—and seek to address the underlying emotion behind their resistant attitude.

During the final stages of Alzheimer's disease, it is not uncommon for patients to stop eating and drinking, as they often lose the ability to chew and swallow. Depending on how much reserved fat a person has, it is possible for a person to last a few weeks without eating, though the body will weaken considerably as time goes on. Hydration, however, is another issue. Generally, most people cannot survive more than a few days without water or fluids. Please talk to a counselor, your family or friends, or if you prefer, a family cleric for support and guidance during this time. At this advanced stage of the disease, there may not be anything else that can be done for your mother. This must be an extremely trying time for you, but you can take some comfort in the knowledge that her pain will soon be over.