The 36-Hour Day, 4th edition: The 36-Hour Day: A Family Guide to Caring for People with Alzheimer Disease, Other Dementias, and Memory Loss in Later Life, 4th Edition

349 Pages·2006·0.89 MB·English

by  Nancy L. Mace

The 36-Hour Day
Nancy L. Mace, M.A.
is retired. She was a consultant to and member of the board
of directors of the Alzheimer’s Association, and an assistant
in psychiatry and coordinator of the T. Rowe and Eleanor
Price Teaching Service of the Department of Psychiatry and
Behavioral Sciences of the Johns Hopkins University School
of Medicine.
Peter V. Rabins, M.D., M.P.H.
is professor of psychiatry, with joint appointments in medi-
cine, mental health, and health policy and management;
co-director of the Division of Geriatric Psychiatry and Neuro-
psychiatry; and director of the T. Rowe and Eleanor Price
Teaching Service of the Department of Psychiatry and
Behavioral Sciences of the Johns Hopkins University School
of Medicine.
A Johns Hopkins Press Health Book
The
36-Hour
Day
A Family Guide to Caring for
People with Alzheimer Disease,
Other Dementias, and
Memory Loss in Later Life
FOURTH EDITION
THE JOHNS HOPKINS UNIVERSITY PRESS
Baltimore
∫ 1981, 1991, 1999, 2006 The Johns Hopkins University Press
All rights reserved. Published 2006
Printed in the United States of America on acid-free paper
9 8 7 6 5 4 3 2 1
The Johns Hopkins University Press
2715 North Charles Street
Baltimore, Maryland 21218-4363
www.press.jhu.edu
Words from ‘‘Joy Is Like the Rain’’ by Sister Miriam Therese Winter
∫ 1965 by Medical Mission Sisters, Philadelphia, Pa.
Reprinted by permission of Vanguard Music Corp.,
1595 Broadway, New York, N.Y. 10019
Further reproduction prohibited
Library of Congress Cataloging-in-Publication Data
Mace, Nancy L.
The 36-hour day : a family guide to caring for people with Alzheimer disease,
other dementias, and memory loss in later life / Nancy L. Mace, Peter V. Rabins. —
4th ed.
p. cm. — (A Johns Hopkins Press health book)
Includes index.
ISBN 0-8018-8508-6 (hardcover : alk. paper)
ISBN 0-8018-8509-4 (pbk. : alk. paper)
1. Alzheimer’s disease—Patients—Home care. 2. Senile dementia—Patients—
Home care. I. Rabins, Peter V. II. Title. III. Title: Thirty-six hour day. IV. Series.
RC523.M33 2006
362.196%831—dc22 2006009627
A catalog record for this book is available from the British Library.
This book is dedicated to everyone
who gives a ‘‘36-hour day’’ to the care
of a person with dementia.
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Contents
Foreword xvii
Preface xix
Acknowledgments xxi
1 Dementia 1
What Is Dementia? 5
The Person with Dementia 7
Where Do You Go from Here? 9
2 Getting Medical Help for the Person with
Dementia 11
The Evaluation of the Person with a Suspected Dementia 12
Finding Someone to Do an Evaluation 15
The Medical Treatment and Management of Dementia 16
The Physician 16
The Nurse 17
The Social Worker 18
The Geriatric Care Manager 19
The Pharmacist 19
3 Characteristic Behavioral Symptoms of Dementia 20
The Brain, Behavior, and Personality: Why People with
Dementia Do the Things They Do 20
Caregiving: Some General Suggestions 23
Memory Problems 26
Overreacting, or Catastrophic Reactions 27
viii Contents
Combativeness 31
Problems with Speech and Communication 32
Problems the Person with Dementia Has
in Making Himself Understood 33
Problems the Person with Dementia Has
in Understanding Others 35
Loss of Coordination 38
Loss of Sense of Time 41
Symptoms That Are Better Sometimes and Worse at Other
Times 42
4 Problems in Independent Living 44
Mild Cognitive Impairment 44
When a Person Must Give Up a Job 46
When a Person Can No Longer Manage Money 47
When a Person Can No Longer Drive Safely 48
When a Person Can No Longer Live Alone 52
When You Suspect That Someone Living
Alone Is Getting Confused 52
What You Can Do 55
Moving to a New Residence 55
5 Problems Arising in Daily Care 59
Hazards to Watch For 59
In the House 60
Outdoors 63
In the Car 64
Highways and Parking Lots 64
Smoking 64
Hunting 65
Nutrition and Mealtimes 65
Meal Preparation 66
Mealtimes 66
Problem Eating Behaviors 68
Malnutrition 70
Weight Loss 70
Choking 71
When to Consider Tube Feeding 72
Contents ix
Exercise 74
Recreation 75
Meaningful Activity 78
Personal Hygiene 78
Bathing 80
Locating Care Supplies 82
Dressing 82
Grooming 83
Oral Hygiene 84
Incontinence (Wetting or Soiling) 85
Urinary Incontinence 85
Bowel Incontinence 89
Cleaning Up 89
Problems with Walking and Balance; Falling 91
Becoming Chairbound or Bedbound 92
Wheelchairs 94
Changes You Can Make at Home 94
Should Environments Be Cluttered or Bare? 96
6 Medical Problems 98
Pain 100
Falls and Injuries 100
Pressure Sores 101
Dehydration 101
Pneumonia 102
Constipation 102
Medications 103
Dental Problems 106
Vision Problems 107
Hearing Problems 108
Dizziness 109
Visiting the Doctor 109
If the Ill Person Must Enter the Hospital 110
Seizures, Fits, or Convulsions 111
Jerking Movements (Myoclonus) 113
The Death of the Person with Dementia 113
The Cause of Death 113
Dying at Home 114