June is Alzheimer’s and Brain disorder awareness month and here at Voyage we are constantly striving to improve the lives of all our residents within our memory care unit. Over the last couple years major renovations have been made to our memory care unit to promote healthy, natural cognitive function and creating an Alzheimer and dementia friendly environment.
Alzheimer’s is a complex disease that targets specific neuron clusters and neuron connectors, causing the network of brain cells to begin to die off and eventually causing the brain matter to shrink. These changes in the brain can begin up to a decade before symptoms begin, which makes testing and keeping an eye out for signs that much more important.
Giving care to someone who has been diagnosed with Alzheimer’s or dementia can be incredibly difficult for both care giver and receiver. Patients exhibit an increase in aggressive behavior usually brought on by confusion from memory loss, problems communicating as words and names become harder to recall, and sometimes hallucinations or paranoia can become symptoms as well.
Before dementia or Alzheimer’s can progress to that however, there are some signs that every caregiver or loved one of an older persons can keep an eye out for. According to the National Institute of Aging (NIA), while memory problems are usually the beginning signs of cognitive impairment, the first symptoms of Alzheimer’s can be different for everyone.
THE HISTORY OF ALZHEIMER'S
Dementia has been recorded since the time of the ancient Egyptians, by 2000 BC the ancient civilization had already determined and wrote about how aging causes memory decline. It was recorded again by Pythagoras, Plato and Hippocrates, prominent Greek philosophers and doctors, who agreed with the Egyptians that age was the cause of memory degradation. Around 100 B.C., however, another Greek philosopher and politician named Marcus Tullius Cicero pointed out that not everyone who was older, had memory problems, making him the first to indicate that dementia was not a direct cause of aging.
Around the second century A.D., dementia was split into two groups, delirium which was reversable and dementia which was irreversible. With the rise of the roman empire in the 5th century many scientific and medical studies were set back hundreds of years, suddenly dementia was caused by the biblical sins of man.
For over a thousand years dementia research would lay dormant to the world, in 1608 when William Shakespeare introduced King Leer, a character who symbolically portrayed many dementia symptoms. 60 years later, vascular dementia was described by the same man who would coin the term ‘neurology’ into the medical world, Dr. Thomas Willis. Over the 200 years following Dr. Willis many new discoveries in the medical world came to light, including new research on dementia.
In 1901, a 51-year-old woman, Auguste Deter, was recommended admission to the Frankfurt Mental Hospital, it was here that Dr. Alois Alzheimer was working. Over the next 5 years, Alzheimer would watch over the woman each day, noticing small details of her condition. Unfortunately, in 1906 Auguste passed after a long fight with both her rapidly declining body and brain, and a particularly rough bout of pneumonia. During her autopsy, Dr. Alzheimer discovered just how Auguste’s mental illness took effect so quickly and caused such a rapid decline of health. What should have been a healthy and full 55-year-old brain, was found to be completely atrophied and ‘tangled’.
In 1980 the Alzheimer’s association was founded, pushing for advocacy and research in using modern technology, they also began pushing for a way to slow down the disease while working towards a cure. Three years after their founding in 1983, President Ronald Regan introduced Alzheimer’s and Brain disorder awareness month saying in his speech, “the emotional, financial and social consequences of Alzheimer’s disease are so devastating that it deserves special attention.”. This emotional speech came 10 years before President Regan would be diagnosed with Alzheimer’s himself, years after the speech it would also be revealed that President Regan’s mother, Nelle, also suffered
from Alzheimer’s later in life. While Regan appointed November to be Alzheimer’s awareness month, the Alzheimer’s Association has designated June as Alzheimer’s awareness month, both are still recognized nationally and internationally.
In 1993 the first FDA approved drug that was proven to slow Alzheimer’s was approved and last year in 2021 the first new Alzheimer’s drug in 17 years was approved as multiple medical research institutions continued their research into Alzheimer’s. New evidence on testing and biomarkers has been advancing for the past 15 years, leading medical professionals closer to their end goal of a cure.
THE SIGNS
Every 65 seconds someone in the world develops Alzheimer’s.
It’s a scary fact, but a fact none the less. 55 million people worldwide suffer with Alzheimer’s. 6 million are in the United States. Within Oklahoma there are 67,000+ people who are currently living with Alzheimer’s and over 120,000 caregivers working to give their patient or loved one the best they can.
Many people experiencing their first time around Alzheimer’s are surprised to find out that many first signs are nonmemory aspects of cognitive function; things like depth perception, impaired judgement and recognizing the passage of time can act as some of the first indicators. Forgetting words or names, difficulty completing tasks, and the inability for the patient to trace their own steps can also be signs of a worsening Alzheimer’s condition.
That is not to say however, that if an older loved one or someone in your care is experiencing these that Alzheimer’s is the reason, alongside Alzheimer’s there are a multitude of other dementia-based conditions. Conditions like Mild Cognitive Impairment (MCI), Lewy Body dementia and vascular dementia can exhibit many of the same traits as Alzheimer’s.
ADJUSTING YOUR HOME
After an Alzheimer’s diagnosis there are a multitude of easy changes that can be made to a home, apartment, or bedroom to help alleviate some of the confusion and be a generally dementia/Alzheimer’s friendly area.
1. Recognizable door décor
Having a simple recognizable wreath, or colored door décor is a great way to help someone effected by Alzheimer’s. Oak Hills Care Center, which is managed by Voyage, will be introducing these wreaths into our memory care unit later this year, using recognizable flowers and colors for each room we hope to make residents feel more in control and more at home with simple but meaningful additions.
2. Photos and artwork that promote good memories
‘A picture is worth a thousand words’ but in memory care a picture can be a direct connection to a happy memory or many. Pictures from when the patient was younger, with family or friends can be incredibly beneficial for any dementia patient. Paintings or artwork with calming colors and images are also beneficial.
3. Glare free lighting
This can be achieved a multitude of ways, anti-glare LED light bulbs, anti-glare filters and more. Soft white LED or any LED light that gives off less than a 19 on the Unified Glare Rating (UGR). Filters on windows or objects that tend to have a glare can be beneficial as well, within our own memory care unit each window in the common area is fitted with a filter which eventually becomes an image as the sun sets.
4. Blue light
Using blue light during the day can help with alertness, reaction time and if used correctly can even help balance circadian rhythms (sleeping and waking patterns). While everyone should avoid using blue light at night, the introduction of blue light to a patient can help reduce mood swings and decrease agitation. Before implementing blue light into your or your loved one’s lives, please consult your attending physician.
5. Relaxing colors that enhance depth perception
Mixing darker calming colors (like blues, dark greens and purples) with brighter colors (like white or yellow) into room design can be extremely beneficial for patients. Layering darker colors closer to the desired focal point, while keeping the main walls the lighter color can aide in depth perception as patients get further along.
6. Easy-use replacements
Every year more and more “easy-use” items are released and many of them have been shown to aide with not only dementia/Alzheimer’s but many other mental and physical disabilities. Big button remotes, such as the Flipper Big Button or any Universal Big Button, are great for those that get confused by current remotes that can seemingly have hundreds of buttons. Big button remotes generally have power, sound, and channel buttons only, though some higher end ones can be purchased with preset buttons that can be loaded with your loved one’s favorite channels to help decrease confusion even more.
Large text clocks that show not only time and the date but reminds exactly which day of the week as well can be extremely beneficial, having more than one around the house can help ground the patient and help with their perception of time and seasons. Some clocks can be chosen to show temperature, season, and even with part of the day shown with a helpful image.
Standing dressers are easier for those with squatting or leaning difficulty, and the addition of labels that both say what in the drawer but have helpful images can be beneficial as well. Use a mix of knobs and handles to help with grip and hand movements.
Photo based dialing phones can also be extremely helpful, images and names help the patient not only remember the names and faces of loved ones and friends, but they are also able to easily get in contact with the person they were meaning to without getting confused about the numbers they have already dialed, making sure it’s the correct person, and more. Alternatively, if your loved one has a problem remembering how many times they are calling certain people, incoming call only phones are also an option, many of these phones are still able to dial emergency numbers for the safety of the resident.
Ergonomic silverware, cups, and raised plates/bowls can also be extremely beneficial for dementia/Alzheimer’s patients. Weighted silverware can help with shaky hands while ergonomic mugs are more comfortable on any side hand to hold. Raising bowls and plates means there is less distance for the fork or spoon to travel causing a large reduction in spills and helping the patient feel more independent.
7. Keeping a set schedule
Schedules can help anybody keep track of their day or week, but they can be exceptionally helpful for those dealing with memory problems. Having a clearly visible schedule with reminders to eat, take medications, getting dressed, etc. can help ground patients and loved ones as they move throughout their da remembering to look at the clock and list. Patients and residents have been shown to begin to pick up on time passing before even glancing at the clock, knowing that it is getting close to time to take medications or do hobbies. When creating this schedule remember to add as much as is needed, some schedules can include wake up and bedtimes, mealtimes, time set aside for hobbies, bathing, even dressing themselves.
8. Easy-use, loose fitting clothing
Using loose fitting clothing like joggers or pants with elastic waistbands can help the patient/loved one feel more independent as they are able to dress themselves. For those loved ones that have specific style choices, replacing normal buttons with magnetic ones, or a zipper can be extremely beneficial. Zippers should be used with an extra zipper tab pull, this small piece of fabric, string, or nylon can help the patient grasp the zipper with ease and increase grip.
9. Safety touches
Much like what you would add to a house with a younger child, safety features should be retrofitted around the home or areas that the patient/loved one is in. Plastic covers for corners and cabinet locks for drawers/cabinets with sharp objects can keep your loved one safe from accidentally harming themselves. A security system that alerts caregivers of when windows or doors are opened can be beneficial if your patient/loved one has a wandering problem. Stove covers and automatic fire extinguishers for stove range hoods are a great option if your loved one struggles with forgetting to turn off the stove or accidentally turns it on.
OUR MEMORY CARE UNIT
the only memory care unit in our management, Voyage and Oak Hills employees push for it to be as accessible, therapeutic, and helpful as we can make it.
As previously mentioned, Voyage has made a multitude of improvements to the memory care unit, some of these changes include the use weighted silverware, raised bowls and ergonomic mugs. Another way we are helping improve the lives of our residents was the inclusion of a timeline graphic of celebrity figures and films to help visualize the passing of years. Some of the included celebrities are Charlie Chaplin, Joan Crawford, Marilyn Monroe, John Wayne, and Harrison Ford. We also included two of the most recognizable movies of the decades from the 1920’s through the 2010’s, as well as a selection of recognizable scenes and characters.
Opposite the movie timeline wall is a small faux town that residents can still interact with at many levels. An auto shop allows patients to open parts of the door and interact with a pully system. A “laboratory” allows patients to interact with a series of buttons which can be pushed. The post office allows patients to open both a letter box and a newspaper box where they can leave letters or notes. The hardware store houses a variety of locks, knobs, and faux tools where patients can work on some fine motor skills. Finally, the flower shop allows patients to interact with a variety of faux flowers, all labeled to help increase recognition.
We have also introduced a variety of other fine and general motor skill activities, including a Wii Wall where patients can play a variety of WiiSports and other Wii games, a sewing activity in which patients are able to use dulled easy thread plastic needles to sew pieces of fabric together (this is done under constant supervision to ensure patients are unable to accidentally harm themselves or others), VR therapy has been recently introduced (check out our other blog posts about that to learn more!). Mealtimes have become another place where we help make sure that brain stimulation is used to its best effect, by specifically choosing different foods and textures for each patient and meal we are able to increase or decrease stimulation.
A Beam is coming to Oak Hills in the coming months as a new form of physical and mental therapy as well. A beam is a VR experience where an interactive projection is shined onto the floor, we hope to have this up and running soon!
LINKS FOR CAREGIVERS
The Oklahoma chapter of the Alzheimer’s Association is always available to help those currently living with or caring for someone who lives with Alzheimer’s and has virtual education programs running all year round which can be found at: https://www.alz.org/events/event_search?etid=6&cid=147&zip=74133
For those outside of Oklahoma or for more general information on caregiving for your loved one at any stage please visit: https://www.alz.org/help-support/caregiving
This virtual library of link from the Alzheimer’s association also offers a variety of information and helpful links for caregivers, patients, and anybody generally interested in knowing more about Alzheimer’s: https://www.alz.org/help-support/resources/virtual_library/favorite_links