Preserving dignity and quality of life for the Alzheimer’s sufferer

By Micha Shalev

The concept of dignity is subjective and may have different meanings for each person. It is beneficial to have an understanding of what the resident was like before the illness. Remember that several aspects of individuality must be met:

•The identity of the person: How does he or she wish to be addressed? Is there a title, such as doctor, that is appropriate?

•Respect for privacy: A person who has always disrobed in private may react negatively to being undressed by a stranger.

•The appearance of the resident: Attending to grooming and personal hygiene can improve a resident’s self-esteem.

•The resident is an adult: Even though cognitive deficits exist, the resident has experienced the joys and challenges of several decades of living. To treat residents as children is inappropriate and demeaning. Using words and touch so they feel valued as individuals are beneficial. People with Alzheimer’s Disease (AD) still have a need to make contributions and to feel that they have some control over their lives. They are more content when they are encouraged to remain active and involved, using their remaining strengths and abilities.

•Physical and psychological comfort: People with AD have the same basic needs as healthy individuals. Unmet needs will be reflected in the resident’s behavior. The behavior will not change as long as the need remains unmet. Meeting physical needs can prevent discomfort related to hunger, thirst, restlessness, constipation, or the desire to void.

•When people do not feel safe they become anxious: If residents feel threatened they may strike out verbally or physically. Persons with AD may feel unsafe much of the time because they do not understand the environment and what is going on around them.

•People with AD also need to love and be loved: They have positive and negative feelings. They should be touched, hugged and have eye contact with caregivers. Care providers should converse with them on their level without being condescending, compliment them on their appearance, and provide quiet, private areas for visits. Spouses should know that it is acceptable to express affection.

•It is useful to plan activities compatible to the abilities of each individual so they can experience a feeling of success.

•Listen to the resident. What is expressed may not sound rational to others, but it does to them.

Family and staff should consider the wishes of the resident before initiating a treatment that may prove to be more harmful than beneficial. For example, starting an IV for feeding or administering antibiotics for an infection may not be in the best interests of the resident if he or she must be restrained to prevent dislodging of the needle. Acknowledge the individual’s autonomy. When a resident is too demented to make decisions, the family must consider what their loved one would have wanted rather than what they themselves want.

Be honest with AD residents while being optimistic when answering questions. Let them know that although the disease is progressive and there is no cure, there are still treatment options. Honesty from caregivers often encourages residents to consider the future and to make decisions about what they want as their condition worsens.