The theory of retrogenesis is simple
- Once a man, twice child - meaning that we start out in life as a child, grow into an adult, then as we age and lose abilities, both physical and cognitive, become child again.
So the question I always ask a brand new group of caregivers is (after learning that the majority has children), "When you brought you brand new baby home from the hospital and that baby was crying, what do you think was wrong and what did you do to soothe it?". Here are some of the answers:
*Change the baby's diaper
*Feed the baby
*Maybe it has a bellyache now, burp it
*Check for fever
*Hold the baby
*Lay the baby down for a nap
*Is it too hot? change it's outfit
*Is it too cold? wrap the baby in a blanket
*Is the clothing it is wearing too tight? too itchy?
*Is the baby bored or lonely? Play with it
*Is the baby constipated?
*It must have it's days and nights mixed up, I'm going to try to keep the baby awake during the day and put it to bed at a certain time each night
*Call my mother! I don't know what else to do!
*We've tried everything else, it's still crying, I'm taking my baby to the doctor
The baby cries because it has no other way to communicate.
When we hear our babies cry, we tend to it's needs because we know that there is probably a good reason it is crying.
Once we understand our baby's needs, we may become proactive and get the baby into a feeding, sleeping, diaper changing, bathing, playtime routine.
When someone has an Alzheimer's diagnosis or another form of dementia, they slowly lose the ability to communicate needs as they once did, lose the ability to satisfy their own needs.
So we as caregivers, we must learn their needs and either adapt to their routine or slowly get them into a safe and healthy routine.
When a baby cries, it probably has unmet needs. When a person with dementia becomes anxious, agitated, sad, exhibits unusual behavior - it is likely that they have an unmet need and have no other way to express the need.
So we must go through the checklist, as we did with our babies to make sure they are happy, safe and content.
Here are some things you can do to become proactive in meeting our loved ones needs:
Routine, Routine, Routine
1. Establish regular meal and snack times - this is especially important if they also have diabetes to maintain normal blood sugar level and if they are taking medications for any reason
2. Establish a toileting routine - incontinence isn't always a result of not knowing they have to use the bathroom, when it comes to someone with a dementia diagnosis it may be that they don't know where the bathroom is, they can't get to the bathroom quickly enough.
If we take them to the bathroom every 2-3 hours, learn their routine/toileting habits, we may be able to prevent accidents and the anxiety they likely feel when they do know they have to go but have no idea how to get there.
3. Is someone refusing to bathe? What did they do most of their lives- bathtub or shower? If you are trying to shower someone who traditionally took a bath, you may be fighting a losing battle, so you need to adapt by keeping water out of their face.
Try to accommodate their preference and take into consideration what time of day they typically took a bath or shower.
4. Give their medications at the time of day they which the prescription indicates. If you think a certain medication is making them too sleepy during the day, ask the doctor if the time of day can be changed.
Ask the doctor if the medication can be given with food. Some of the "Alzheimer's medications" cause stomach ache but are tolerated better when given with food. Some medications cannot be absorbed well if they have just eaten so find out what is the proper time of day, and if it is best or bad to take with food.
5. Have they had a sudden change in behavior? More confused, agitated or anxious than usual, combative? Maybe there is another health issue going on like an infection, a urinary tract infection (that doesn't always present with noticeable symptoms that a younger person may experience), If the change is sudden and uncharacteristic, get them to the doctor asap.
6.Are they asking for someone that isn't here? Asking for their husband, mother, sister who has passed? Maybe they just need the love that person would have given them at this moment - give them a hug.
7. Have they had a lot of visitors today? Have you taken them out of their routine? Have they had a lot of doctor appointments today? Maybe they have been over-stimulated. Keep visitors to a minimum or set a time limit.
When you have them back in their comfort zone, give them relaxing things to do, maybe a nap wouldn't be a bad thing.
8.As we age, our body changes, as we become less active, there may be a weight gain. If the dementia has caused them to not recognize when they are hungry , they may lose weight.
Our mouth changes and dentures may not fit properly, causing problems with eating. Medications and other health concerns nay cause edema (swelling) so clothing and shoes feel uncomfortable.
Take them to the dentist, to the podiatrist, keep track of weight gain or loss and take those things into consideration when dressing them. Maybe it's time for new clothing or shoes.
As we age, our skin thins and becomes more sensitive - maybe that wool sweater they've worn for years is now itchy. Loose fitting, comfortable clothing will not only feel better for them but make it easier in getting them to change or having to change them.
Take into consideration that because their skin has thinned, there is less muscle to keep them warm, they may need warmer clothing than you.
9. Troubles with sleeping during the day, up at night? Set a scheduled wake time, a scheduled bedtime. Give them things to do during the day, keep them engaged in what you are doing. Maybe a change in scheduled medications to a different time of day may help - check with their doctor before doing so.
10. You've tried everything and still they aren't sleeping, are anxious, agitated - make a doctor appointment, ask for lab work to be done, keep a journal of changes in behavior, sleep patterns, eating habits and share the changes with the doctor.
11. Maybe you need a little extra help. Enlist other family members to do the grocery shopping, help preparing meals, taking your loved one to appointments, clean the house so that you can get some relief. Didn't we all call our Mother's when we didn't know what else to do?
By Karen Francis - Speaker, Educator and Caregiver Support
To watch Karen Frances' video on the subject please click here.