The professional experience since several years leads the staff of the Special Acute Care Unit to examine their Care Practices.
A better knowledge about the Alzheimer’s Disease and its consequences enable us to provide adapt and personalized Care.
Our Staff expert mission is to share our abilities and knowledge. In that way, our staff set up, for some fundamental needs disturbed along the course of Alzheimer’s Disease specially mobility, alimentation and personal care , a list of actions and strategies of management. The goal is to restored or maintained the autonomy, giving back the self respect and the dignity of the patient.
We have set up practical guides for the family or other members staff caring for people with Alzheimer’ Disease and other dementia

There is a risk of both under-nutrition and dehydration ; It is therefore important to keep a close eye on food and drink intake. Reduced food intake, be it due to forgetfulness or refusal of food, causes nutritional deficiency leading to loss of weight, strength, and subsequently of mobility and autonomy. This in turn will affect all aspects of daily life and potential skin problems. Dehydration can set off a similar train of events but which develop much more quickly. It is therefore important to ensure a daily intake of around 1.5L of fluid.
Monthly weighing of the patient is advised in order to detect early weight loss.
How to promote food intake when the patient refuses to take anything at all.

Consider

• Regular, normal meal times
• Appropriate presentation of food (normal, mixed, liquidised)
• Patient’s food preferences
• Discomfort ;
• Check :
  The mouth (dental and oral hygiene require regular visits to the dentist)
  The throat, the digestive tract (constipation)

Faced with refusal
Wait a while and try again

• Try a spoon rather than a fork
• Explain the importance and benefits of the food presented
• .If the patient gets up during the meal, try to distract his attention with conversation (his past, his family his job etc)
• If that doesn’t work, try food which can be given and eaten while walking ; the important thing is that the patient gets enough food
• If the patient drinks freely but won’t eat, liquid nutritional supplements (on prescription) may be given.
• Try mid-morning and mid-afternoon snacks.
• Encourage green vegetables (containing fibre) to avoid constipation. It is important to keep an eye on the patient’s bowel habit.
• Try to encourage physical exercise (walking, going up or down stairs, household tasks, meal preparation)
• Let the patient eat alone as much as possible, even if this is not totally satisfactory in every way.

How to encourage drinking

• Consider the patient’s preferences : hot or cold drinks, flavoured or not, enriched if necessary
• Cups and mugs should be appropriate ; not too heavy, easy to hold and with a lid or beaker if necessary.
• Watch out for patients wandering a lot or leaning over to one side : these could be signs of dehydration

Goal

• to maintain autonomy as long as possible
• to help the patient to re-learn the basic steps by setting feasible goals - encourage him or her by demonstrating the benefits of good hygiene

What to do

a) making contact - it is very important to communicate with the patient, both by word and gesture.
For example : say hello, take their hand, ask if they have slept well, stroke their hair or cheek

• if the patient resists or is aggressive, create an atmosphere of confidence.
  For example : speak calmly, use the patient’s Christian name or the name the family uses (explain to them that this does not mean any lack of respect) ; however, the use of Gran or Grandad:is to be condemned : we are all adults.

b) the procedure of washing, dressing, etc.

• explain to the patient what you are both going to do.
• take the patient to the toilet just before starting, so that communication will not be interrupted and the efforts of patient and carer wasted.
• assist or stimulate the patient according to his or her degree of autonomy, respect his or her modesty and wish for privacy.
• if the patient is agitated : the need to pass water or stools causes agitation and even if the patient is incontinent he or she should be taken to the toilet to prevent incidents during care.
• if the patient is aggressive : to avoid a blow, never stand in front of the patient. Get the patient to hold the washbasin or shower rail with one hand : he or she must be kept occupied.
  For example : rinse the patient’s hands under running water, this gives a feeling of well-being.
• if the patient resists and will not be washed, do what you can, leave the patient alone a moment, then come back as if nothing had happened and try again. If the patient again refuses, try again the next day.

c) useful hints

• use quick, assured gestures :
  remember that the Alzheimer patient is impatient.
• shampooing is taken as an aggression, wash the patient’s hair only when necessary.
• soap in the eyes is unpleasant, wash the face with fresh water.
• brushing the teeth is very disagreeable : rinse the mouth with fresh water or use a damp swab with the fingers. Avoid forceps which are too aggressive and could hurt the patient
• Concentrate on the person rather than on the task.
• Washing and dressing a patient who has to be stimulated takes much longer, but this is not time wasted, in fact it is time won against the disease.

Assistance walking (nurse assistant)

Lately, we take of patients who lost their moving autonomy, either by fear of falls or because of previous contentions during most of the time during the day or because their moving space was too narrow (bed to chair). With simple instructions, helping patients to move to the dining-room to eat (and not in their bedroom), being no more confined in bed during the day, with the incentive participation of all the staff.
The change is rapid : after three days of hospitalization most of the patients begin to walk again. Before this action we receive a training by physiotherapists.

Soft exercise

Twice a week we organize one hour of soft setup by nurse assistant and auxiliary nurse.
The session begin by some joints warm-up, physically compulsory and generating a better relationship between the patients and the team.
We proposed a succession of adaptable exercises with three main goals : help them to have a better body self-consciousness to prove them that there are always able to reach a goal doing some physical activities, and by this way enhance their memory capacities.

Session example :

• warm-up : turnround of ankles, to throw up the knees, the arms...
• For ball games
  Squeeze the ball between thighs and relax.
  Press a ball in the hands and relax
• As the memory game :
  Counting and naming of each hand fingers, naming of the different parts of the body.
  Remember and give back the color of the ball...
  Remember the meal composition at lunchtime
  At the end of the session a snack is rewarding.