The following section deal with approaches to problems that are commonly encountered when caring for people with memory loss. While there are no definitive answers to these problems, the approaches suggested may help.

1. Bathing

Many patients go through a phase where they either refuse to bathe or tell you they have already finished their bath. This can be frustrating, especially if the patient develops body odor. The first (and most important thing) to remember is that no one ever died from not bathing. Many older adults are modest about disrobing, or become afraid of bathwater or the shower. Some of the following suggestions have been helpful: Let the patient choose the time of day to bathe Remind him/her of a special occasion they must be clean for (e.g., "we canít go out for lunch until you bathe") Associate a pleasant experience with the bath (such as a chocolate treat or music) Make sure you check the temperature of the bathwater or shower to prevent freezing or scalding. Color the bathwater or use bubble bath Try a hand-held shower head so water does not hit the person's head Allow the person to bathe with underwear on Sing during bath-time to relieve the tension or have some soft music in the background. Compliment the patient after the bath Don't take refusals to bathe personally.

2. Wearing the same clothing day after day

This is an indication that the patient can not handle change and is normal for people with memory loss. Purchase several identical outfits when shopping. Then, when the person takes one set of dirty clothing off, remove it and replace with an identical set of clean clothing. Make sure you have a picture of your loved one in this clothing in case they wander. You will be able to tell the police exactly what the person is wearing.

3. Hiding things

Hiding and losing things are the most frustrating aspect of the disease for many caregivers. Understand that hiding things often represents a concern about theft. Things will be hidden.

It is important to minimize the loss of money and valuables. Remove valuables from the house whenever possible. Remember, these possessions still belong to the patient and can not legally be dispersed using the patient's will.

Take larger valuables such as the family crystal, silverware, and china, and pack them away. Label the carton "books" or something that does not attract attention and place them in a safe area, such as a little-used closet or basement. Place jewelry not used daily in a safety deposit box.

Take jewelry worn daily and have it appraised. Have the jeweler remove the most valuable stones and place them in a safety deposit box. Replace the valuable stones with cubic zirconium and return to the patient.

Never ever send jewelry you do not mind losing with the patient to a nursing home or assisted living facility.

Put "clappers" on house and car keys so they beep when lost Get to know where some of the more common hiding places are.

Families report hiding money, keys, jewelry, medications, and many other things in the following locations:

under the mattress
in the pages of books
in the hems of curtains
under the paper in back of pictures or mirrors
under pillows
in food containers
in the freezer
behind bricks in the basement
in breakfront cabinets
wadded in tissues in toilet paper cardboard cylinders in the trash

It is important to remember that things will be lost. Make sure that there are duplicates of keys and other items. Also, losing the car keys is an excellent way to have your loved one stop driving. This is one example where you may decide to let the keys "stay lost" and not volunteer another set.

4. Fear of abandonment/refusing help

Many patients refuse to go to adult day programs or to allow in-home respite services. Patients become dependent on their caregivers to remember when they can't and become nervous and upset when their caregiver is not around. This can become so severe that the caregiver is unable to have even a moment alone, including to go to the bathroom. The best defense against this is a good offense. Have your loved one go to day programming. Have extra help in the home as early as possible, usually a cleaning person, so the patient is used to having others around. Make sure that family members participate in care on a regular basis and, if possible, friends take the patient out whenever possible.

If the patient becomes enraged when a service provider or family member is used for respite, understand that this is not uncommon. Insist that you need your time and space. Gently reinforce that staying alone or going with you is not an option. Insist that you will try to find respite workers that the patient likes.

The first time or two the patient attends day care or has a new respite worker, stay with him/her during the event. As your loved one becomes accustomed to the day program or respite worker, anger will subside. Successful adaptation to respite will keep your loved one at home longer and will help to keep you from feeling trapped.

5. Aphasia

Loss of language abilities are a usual part of memory loss. Loss of reading comprehension generally occurs first. One of the ways to determine this is if mail starts to pile up or the person begins to pay anything that even resembles a bill. Another clue is when the person either stops reading the paper or can't tell you what they have read.

When the person starts to stumble over words, it is important to understand that they also have trouble understanding what is being said. Talk more slowly using simple phrases. Give the person extra time to respond. Use gestures and point to objects whenever possible.

If the person begins to use words that don't make sense, often called "jargon" or "word salad," try to find bits and pieces that relate to the patientís world. The patient may have good understanding of the world around them, but may simply not be able to express himself or herself.

It is acceptable to explore potential meanings with the patient unless frustration begins to rise. If he/she becomes frustrated, distract them to another task and try later. A single consultation with a speech pathologist may be helpful to develop communication strategies.

If the person develops slurred speech or problems swallowing, speak to your physician immediately. The patient may run the risk of aspirating (breathing it into their lungs) food or saliva.

6. Made-up stories

One of the more frustrating effects of memory loss is called "confabulation." People with brain diseases, especially those that cause memory loss, tend to have their brains "fill in the blanks" when they can't remember what happens. So, the patients come up with stories that they believe are true. Confabulation is not a lie. It is a story the brain makes up. Trying to correct the patient leads to anger and frustration for you both. A good rule is that anything the patient says is fine - as long as safety is not compromised.

7. Repeated Questions

Patients ask repeated questions for several reasons: they can't remember asking the question; they have no sense of time; and the question they are asking is not really what they want to know. When your loved one asks a question over and over, most often it has to do with when or where something will happen. These questions can become obsessive.
There are two rules for these questions:

A. Never announce anything more than 24 hours in advance because it precipitates obsessive questions.
B. When a question is asked more than once or twice, ask "why are you asking?" Then address the underlying concern.

Example:

The patient asks "What day is it?"
You ask "Why do you want to know?"
The patient says "I don't want to miss church."
You answer "I will make sure you get to church on Sunday."

Another strategy is to write the answer on a file card and have the patient carry it in his/her pocket. When the question is asked you direct the patient to read the card.

Supported by: Iowa Scottish Rite Masonic Foundation,
National Caregiving Training Project,
University of Iowa College of Nursing,
Gerontology Nursing Intervention Center
Research Development and intervention Core

Developed by: Geri R. Hall, Ph.D., ARNP, CNS
Gerontology Clinical Nurse Specialist
Mayo Clinic Scottsdale
13400 E. Shea Boulvard
Scottsdale, Arizona 85259
Phone: 602-301-8111
E-Mail: Hall.Geri@mayo.edu