Broken connections : Alzheimer's disease. Part II, Practical guidelines for caring for the Alzheimer patient

288 Pages·1994·1.52 MB·English

by  Franssen

BROKEN CONNECTIONS
The little boy and the old man
Said the little boy, “Sometimes I drop my spoon.”
Said the little old man, “I do that too.”
The little boy whispered, “I wet my pants.”
“I do that too,” laughed the little old man.
Said the little boy, “I often cry.”
The old man nodded, “So do I.”
“But worst of all,” said the boy, “it seems
Grown-ups don’t pay attention to me.”
And he felt the warmth of a wrinkled old hand.
“I know what you mean,” said the little old man.
Shel SilversteinFrom: A light in the Attic,
poems and drawings by Shel Silverstein,
HarperCollins Publishers, 1981
LIDUIN SOUREN & EMILE FRANSSEN
Broken Connections
ALZHEIMER’S DISEASE
PART II—PRACTICAL GUIDELINES FOR CARING FOR THE
ALZHEIMER PATIENT
This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of
thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
Library of Congress Cataloging-in-Publication Data
Souren, Liduïn
[Verbroken verbindingen. English]
Broken connections: Alzheimer’s disease/Liduïn Souren & Emile Franssen.
p. cm.
Includes bibliographical references.
Contents: pt. 1. Origin and course—pt2. Practical guidelines for caring for the
Alzheimer patient.
ISBN 90 265 1334 8 (pt 1).—ISBN 90 265 13712 (pt. 2)
1. Alzheimer’s disease. 2. Alzheimer’s disease—Patients—Care. I. Franssen, Emile
II. Title.
[DNLM: 1. Alzheimer’s disease. WM 220s724v 1993a]
RC523.S6813 1993
616.8'31–dc20
DNLM/DLC 93–25579
for Library of Congress CIP
CIP-gegevens Koninklijke Bibliotheek, Den Haag
Souren, Liduïn
Broken connections: Alzheimer’s disease/Liduïn Souren & Emile Franssen; [transl. from the
Dutch: R.M.J.van der Wilden-Fall].—Lisse [etc.]: Swets & Zeitlinger
Pt.II: Practical guidelines for caring for the Alzheimer patient.
Vert van: Verbroken verbindingen: de ziekte van Alzheimer. Dl.II: Praktische richdijnen voor
het omgaan met de Alzheimer-patient. Amsterdam [etc.], 1993
Met lit. opg., reg.
ISBN 90-265-1371-2
NUGI 759
Trefw.: ziekte van Alzheimer
Translation: R.M.J.van der Wilden-Fall, MBE, MA (Oxon)
Cover design: Rob Molthoff, Linea Forma, Alkmaar
Cover printed in the Netherlands by Casparie, IJsselstein
© Copyright 1994, E. & L.Franssen Souren
This material may not be used without written permission of the copyright owners.
© Copyright 1994, Swets & Zeitlinger B.V.Lisse
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise, without the prior written permission of the publisher.
ISBN 0-203-34509-6 Master e-book ISBN
ISBN 90 265 1371 2 (Print Edition)
NUGI 759
TO OUR PARENTS
FOREWORD
Twenty years ago, Alzheimer’s disease was known to only a handful of
professionals. It is now a familiar term in most households in the United States.
No disease is more dreaded. The loss of cognitive function associated with
Alzheimer’s disease represents the worst fear of old age. Alzheimer’s disease
conjures up the image of a loved elderly relative, alive but unable to participate
in even the rudimentary activities associated with family life. The disease poses
the burden of long and arduous caregiving and constitutes the most profound
personal and family tragedy. It taxes the skills of the most experienced and
dedicated professional and raises the most basic questions about the benefits and
burdens of care.
Over five million Americans are afflicted withe Alzheimer’s disease. Yet an
astounding number of health care professionals and family caregivers lack even
rudimentary information about the disease: its underlying cause, the progression
of symptoms, and perhaps most importantly, strategies for interacting with
patients and their families. Very few comprehensive sources of information about
Alzheimer’s disease are available to family members and health care
professionals. This text by Liduïn Souren and Emile Franssen is a major step in
rectifying this deficiency.
The impetus for the book came from the autors’ familiarity with the care
provided in residential home settings and in nursing homes in the United States
and in Holland. Liduïn Souren has extensive experience as a teacher and
consultant in geriatric nursing. Emile Franssen, a neurologist, is internationally
recognized for his research and clinical expertise in dementia and Alzheimer’s
disease. In their capacity as researchers, consultants and educators, they have
observed that professional and non professional care givers working with
patients with cognitive disorders lack basic information about strategies for
managing the behavioral manifestations of Alzheimer’s disease. They have
found staff highly responsive to their suggestions for managing patients. And,
most importantly, they have seen first hand the improvements which can be
achieved when patients’ dysfunctions are adequately assessed, understood and
remediated.
The book, which is also published in the Netherlands, is divided into two parts.
Part I explores the notion of dementia and its causes. As can only be done when
vii
one has extensive knowledge, the authors are able to distill the essence of the
disease and present it’s pathophysiology in a form which is at the same time
comprehensive and easy to understand. Appropriately titled Broken Connections,
Part I juxtaposes the behavioral manifestations of Alzheimer’s disease with the
underlying neurologic pathology. So, for example, absent-mindedness,
disturbances of day-night rhythm and “sundowning” are explained within the
context of the concomitant neurologic deficits.
Part II of Broken Connections focuses on practical guidelines and is meant for
the primary caregiver of Alzheimer’s patients. The content delineates four stages
which represent the progressive loss of function associated with the disease. For
each stage, the authors provide a scheme of practical suggestions for managing
socio-recreational function, household and daily personal care and hygiene.
Included in this LIMIT scheme is a LIMIT test which poses questions which
objectively determine what patients are able to do. The LIMIT scheme offers
practical suggestions for preserving existing function. In Stage I of the disease,
for example a discussion about handling money provides questions to determine
the degree to which patients can handle money: can the patient distinguish
between less, much and more? Can he name coins and bills and distinguish the
different values? Specific suggestions for helping patients manage money
include encouraging the patient to pay at the check-out and sort change at home
or stack similar coins.
The book is perfused with the authors’ enthusiasm for improving care for
patients with Alzheimer’s disease. Their intent is to tell the reader that the
patients’ behavior can be understood and that there exists a wide repertoire of
activities which can preserve the patient’s function and slow the slope of decline.
By sharing their own and other’s expertise, this book diminishes the isolation of
countless millions of caregivers faced with the daily task of improving the lives
of Alzheimer’s patients.
Mathy Mezey, Ed.D., F.A.A.N.
Independence Foundation Professor of Nursing Educaton
New York University
PREFACE
The authors of this book are both very concerned with the lot of Alzheimer
patients and their immediate caregivers. Through her work as a tutor of nursing
and geriatrics Liduin Souren has repeatedly come across many unanswered
questions from those most closely involved in caring for the patients. Her
husband, Emile Franssen, is engaged on scientific research into the neurological
aspects of Alzheimer’s disease. From the background of his know-how as a
neurologist/psychiatrist he explains the working of the brain and the connection
between the brain and behavior in a readily understandable way. Many of the
questions concerning the uncomprehended behavior of the Alzheimer patient
come up for discussion and become clear to the attentive reader. Attention is also
paid to psychological factors which influence behavior.
Part II deals comprehensively with the “treatment”. On the basis of the
theoretical model from Part I indications are given on the way in which the
patient’s daily life can be structured. Clear and conveniently arranged schemes
show how the caregiver can approach the patient in a manner which makes use
of the possibilities still available, whereby life becomes more bearable both for
the patient and also for the caregiver.
Amongst the many books on these subjects which have appeared during the
last few years, these two books certainly deserve a place for their clarity,
comprehensiveness and the lucidity of the schemes.
The DUTCH ALZHEIMER FOUNDATION is very pleased that these two
compatriots, who live and work in New York, have made their experience and
knowledge accessible to us.
H.W.ter Haar, M.D., Secretary Dutch Alzheimer Foundation
A.S.H.van Moll, Former Director Dutch Alzheimer Foundation
CONTENTS
Introduction 1
CHAPTER 1 THE FIRST SYMPTOMS 4
Survey of LIMIT Scheme 8
CHAPTER 2 STAGE I: SUPERVISION AND STIMULATION 11
Scheme Stage I 16
CHAPTER 3 STAGE II: INTERVENTION 55
Scheme Stage II 60
CHAPTER 4 STAGE III: PARTIAL TAKE-OVER 105
Scheme Stage III 110
CHAPTER 5 STAGE IV: TOTAL TAKE-OVER 171
Scheme Stage IV 173
CHAPTER 6 THE LIMIT TEST 227
APPENDIX PREVENTION OF FALLS 273