Caregivers advised on Alzheimer's patients

When it comes to Alzheimer's disease, Dr. Judah Ronch believes in a "low-tech, high-touch" approach to patient care.

Caregivers, he says, often use common-sense techniques that elicit more cooperation from their charges than complex treatment plans would.

Dr. Ronch, director of LifeSpan DevelopMental Systems of Poughkeepsie (which develops programs to meet the mental health needs of the aging), was one of several experts who spoke this week at a day-long conference in the Albany Diocese on Alzheimer's and dementia.

'I'm me'

According to Dr. Ronch, the medical profession has traditionally looked at people with the diagnosis of Alzheimer's with primary regard to their limitations. But in his many years of working with people who have Alzheimer's, he's heard over and over, "I'm still me."

Those with the disease, he explained, still think of themselves as individuals with a spirit, mind and sense of self, not just a diagnosis. They want to be treated as individuals, not as a homogeneous group, expected to all behave the same way and have the same needs.

In fact, said Dr. Ronch, caregivers who assume all Alzheimer's patients are the same are in danger of "creating an excess disability."

Individual needs

The expert suggested that caregivers shouldn't make assumptions: For example, if a patient wakes up at 2 a.m., it may not be the nighttime restlessness typical of Alzheimer's, but a habit developed when the person used to work nights.

A caregiver who learns such information can work with the person to use it to their best advantage. A patient expressing boredom who happened to work in an office before his illness, for instance, might benefit more from doing paperwork or using a typewriter than playing the kind of "memory game" many Alzheimer's programs employ.

"We have a tendency to infantilize Alzheimer's patients," Dr. Ronch remarked. "Doing adult-oriented things helps preserve a sense of self."

Independence

That sense of self is often seen in Alzheimer's patients who want to be independent. Dr. Ronch noted that people with dementia still see themselves as autonomous, so caregivers must remember that a person who wanders off or gets on a bus by herself isn't doing so to frustrate a caregiver, but because she believes she has a goal in mind.

Caregivers, he said, can find out what that goal is and help the person meet it in another, safer way: If a wandering patient says he's going to work, his caregiver might explain that his job has moved out of town, but he can work at home. A patient worried about her children might be reassured if a caregiver says she's called them and they're okay.

The worst tactic to use with people who have dementia is to force them to realize things they've forgotten. Reminding a person looking for her mother that her mother is dead, for instance, can make her experience the shock and grief of losing her mother all over again.

Tapping strengths

Dr. Ronch believes that a good caregiver is someone who gets to know the people they care for as individuals. Caregivers should also use their own strengths, he said; a caregiver who parents her own children well can use the tactics she's learned to help a patient.

"There's a lot we now know about helping people with dementia that's centered on the quality of the relationship" between caregiver and patient, he said.

Dr. Ronch recommends an "I-thou" relationship: "If I honor you, you're much more likely to honor me."

Three key points

"Care Partners: Providing Hope and Support to Those with Alzheimer's disease and Related Dementias" was held this week at St. Joseph's Provincial House in Latham.

The conference was sponsored by the Avila Institute of Gerontology, Eddy Alzheimer's services at the Marjorie Doyle Rockwell Center and the Albany diocesan Counseling for Laity Office. Professional caregivers and others dealing with people with dementia attended.

At the conference, Dr. Ronch shared three key points with participants:

1. People with dementia want to be treated like they remember themselves, not just as people who can't do things any more because they have a certain medical diagnosis;

2. The "low-tech, high-touch" approach works best: Caregivers should use their own wisdom and common sense in working with patients; and

3. It's important for caregivers to get in touch with the resources in their communities. (KB)

(9/25/03) [[In-content Ad]]