Alzheimer’s disease is a chronic neurodegenerative disease. Over time, brain cells slowly get destroyed impacting thinking ability and memory – even movement can decline overtime. The process is irreversible and eventually grows severe enough to interfere with daily activities of living.
As Alzheimer’s progresses, caregivers (whether its family members or personal support workers) play an increasing role in assisting those with Alzheimer’s disease to complete their daily activities such as eating, dressing, cleaning and helping them get around.
Caring for a loved one with Alzheimer’s Disease is a challenging yet vital role, requiring both emotional resilience and physical preparation. In this article, we will explore how AD symptoms impact a person’s ability to care for themselves, and provide tools and guidance for caregivers on how to safely assist individuals with Alzheimer’s while reducing the risk of injury and caregiver fatigue.
Table of Contents:
- Understanding Alzheimer’s disease
- Common Alzheimer’s disease symptoms
- Stages of Alzheimer’s disease
- The impact of Alzheimer’s disease on caregivers
- Assistive devices and transfers
- Self care for caregivers
- Community resources for caregivers
- Conclusion
Understanding Alzheimer’s Disease
Alzheimer’s disease (AD) is the most common type of dementia, accounting for 60-80% of all cases of dementia. AD can affect the way people think, act, and move.
Research suggests that abnormal buildups of proteins forming amyloid plaques or tau tangles start a decade prior to symptoms such as memory and thinking problems occurring in people with Alzheimer’s disease (AD).
The damage appears to take place in the hippocampus initially, an area of the brain that is essential in forming memories. As neurons start to die, additional parts of the brain are affected and begin to shrink. By the final stage of AD, the damage is widespread and brain tissue has shrunk significantly.
Common Alzheimer’s Disease Symptoms
While the first symptoms of AD can vary from person to person, decline in non-memory aspects of cognition, such as wordfinding, vision and spatial issues, and impaired reasoning are very early stages of the disease.
Other common symptoms of AD include:
- Gait instability
- Muscle weakness
- Increase risk of falls
- Forgetting recent events or conversations
- Confusion with time or place
- Misplacing items
- Poor judgement
- Mood changes
- Sleep disturbances
Stages of Alzheimer’s Disease
Alzheimer’s disease (AD) is progressive and often described in terms of stages – early, middle and late.
Early Stage Alzheimer’s Disease: This is the stage where symptoms are mild. Individuals in this stage are fully aware of their condition and only need minimal assistance. Problems can include memory loss, losing track of dates or knowing current location, taking longer to complete normal tasks, challenged in planning or solving problems, losing or misplacing objects, mood changes.
Middle Stage Alzheimer’s Disease: Symptoms start becoming more noticeable in this stage. Often, more assistance will be needed to help the person living with AD to complete daily tasks. In this stage, increased confusion and memory loss such as forgetting personal history occurs, withdrawal from social activities, difficulties with reading, reduced attention span, and restlessness at night are some of the symptoms that might be observed.
Late Stage Alzheimer’s Disease: In the late stage it can be difficult for individuals to communicate with others or look after themselves. In this stage, individuals cannot communicate, have difficulties swallowing, increased sleeping and no awareness of recent experiences or surroundings.
The Impact of Alzheimer’s Disease on Caregivers
Individuals with Alzheimer’s disease (AD) benefit from the support and interaction from familiar caregivers. As their thinking and memory changes, daily tasks such as going to appointment and cooking become difficult to perform.
As the disease progresses, individuals with AD might need more assistance with personal everyday tasks such as dressing, bathing and eating. With every stage of the disease, the caregiver’s role changes.
Caregivers can face emotional challenges such as feelings of isolation, frustration, difficulties managing stress, and sleep disturbances. Physical challenges such as fatigue and physical pain from lifting, bending, or repetitive movements are also commonly experienced.
Assistive Devices and Transfers
Here we review the steps for three common transfers required to assist someone with AD who is experiencing difficulties sitting up in bed, getting from bed to a wheelchair and standing up from a seated position.
Lying-to-Sitting
This transfer consists of two main movements: log rolling then positioning the patient from side-lying to sitting.
- Stand at the side of the bed where the patient will roll.
- Bend the patient’s knees slightly by supporting their legs and encouraging them to bend both knees.
- Ask the patient to reach over with the top arm to hold onto the bed railing if they are able to, or ask the patient to cross their arms across their chest
- Place one hand on their shoulder and the other on their hip.
- Gently guide their body to roll as one unit (log roll) toward you. Keep your back straight and bend at the knees to avoid strain.
- Position yourself by the patient’s hips and legs. Gently guide the legs off the edge of the bed while keeping one hand on their upper body for stability
- Support their shoulders with your other hand and guide them into an upright sitting position.
- Ensure their feet are flat on the floor and they are balanced before letting go.
Bed-to-Chair Transfer
- Chair Positioning: Place the chair at a 45-degree angle to the bed on the patient’s stronger side, if applicable. Ensure the chair is stable, with brakes engaged (if it’s a wheelchair)
- Prepare the patient: Encourage them to scoot forward so their feet are directly underneath their knees.
- Stand in front of the patient with your feet shoulder-width apart.
- Place your hands on their hips
- Count to three and help them push through their feet as you guide them to stand. Keep your knees bent and back straight
- Once standing, pivot the patient toward the chair. Keep them close to you and take small steps.
- Guide them to the chair by bending your knees and helping them sit back slowly. Ensure their hips are positioned back in the chair.
Sit-to-Stand Movement
- Ensure the patient’s feet are flat on the floor and shoulder width apart
- Scoot them forward so their feet are directly under their knees
- Stand in front of the patient, maintaining a stable base of support
- If the patient can assist, have them place their hands on the arms of the chair to push up
- Encourage them to lean forward slightly (“nose over toes”) to shift their weight onto their feet.
- Count to three, and help them push through their feet while guiding their upper body upward. Use your hands on their hips or gait belt to steady them.
- Once upright, ensure their balance before letting go. If using an assistive device, position it for immediate use.
Physiotherapy can help caregivers by teaching them how to safely move, lift and use assistive devices to prevent injury – both to themselves and the person with Alzheimer’s disease (AD).
Ensuring proper biomechanics during transfers, such as maintaining a neutral spine, and using leg muscles instead of back muscles are important to pay attention to in order to reduce the risk of injury.
Physiotherapists can also recommend appropriate devices such as transfer belts and demonstrate how to use them effectively. This guidance from physiotherapists can empower caregivers to feel confident in minimizing physical strain as they provide care.
Self-Care for Caregivers
Caregiver should recognize signs of burnout and physical strain. If you are a caregiver of someone with Alzheimer’s disease (AD), it is important to recognize the signs of burnout. This can include sleeplessness, social isolation, feelings of anger and anxiety, and reduced concentration.
As a caregiver, it is also important to incorporate exercises that stretch and strengthen the muscles commonly used during patient care, like the neck, shoulders, spine and legs.
Physiotherapy and Massage Therapy
Physiotherapy and Registered Massage Therapy (RMT) can play an integral role in promoting self-care and managing the physical demands of caregiving for individuals with Alzheimer’s disease (AD).
Physiotherapy can help caregivers maintain their physical well-being by providing tailored exercises to strengthen and stretch key muscle groups, such as the neck, shoulders, spine, and legs, which are often engaged during transfers or other caregiving activities. Regular movement and strengthening routines can improve posture, reduce the risk of injury, and alleviate physical strain.
Similarly, massage therapy can provide much-needed relief from tension and pain caused by repetitive movements and prolonged physical tasks. RMT treatments can target areas of muscle tightness, enhance circulation, and reduce stress levels, offering caregivers a moment to recharge both physically and mentally.
By incorporating these therapeutic practices, caregivers can better manage the demands of their role, enhance their overall well-being, and remain effective and compassionate in providing care.
Mindfulness for Caregivers
Mindfulness is the practice of being present and fully engaged in the current moment, without judgment or distraction. For caregivers of individuals with AD, mindfulness can serve as a powerful tool to manage stress, improve focus, and enhance emotional resilience.
By cultivating awareness, caregivers can better handle the challenges of their role while also finding moments of peace amidst their busy routines and reducing burnout.
The benefits of mindfulness for caregivers include reduced feelings of anxiety, improved sleep, and a greater sense of balance and control. Practicing mindfulness has been shown to decrease emotional exhaustion and improve overall well-being.
It also helps caregivers approach difficult moments with greater patience and understanding, which can positively impact their relationship with those they care for.
Community Resources for Caregivers
Every Canadian community has agencies and services that can help you. Services for the elderly and their caregivers vary in different provinces, territories and regions.
You can find out what services are available in your community from a number of sources:
- Your local Alzheimer Society
- Your family doctor, health clinic or social worker
- The public health department in your area
- Community organizations
- Your friends, family, neighbours, especially if they have been caregivers
Services that can help Personal Support Workers include:
- Educational resources: on how to enhance your knowledge and confidence in your caregiver role, such as that through McMaster University
- Self-Care tools provided by provincial governments, such as “Self-Management Ontario – Support for Caregivers” and “Caregiving Strategies”
- Ontario Caregiver Organization that supports caregivers by being the point of access to information
- Supportive Caregiving Services in your region that can include self-help, informal counselling, recreation and resources. This includes Alzheimer’s Society of Toronto, CHATS, Ontario Caregiver Organization and Alzheimer Society Peel.
Services that can help families that have a loved one with AD include:
- Homecare workers: They provide personal care at home, helping with eating, dressing and bathing as well as light household tasks.
- Housekeeping services: These usually include cleaning, shopping, laundry and meal preparation.
- Skilled nursing services: Nursing services provide trained professionals in the home.
- Meals on Wheels: These programs offer home-delivered meals to help provide well-balanced lunches and dinners.
- Volunteer/friendly visiting: These provide a friendly visitor (paid or volunteer) to spend time with the person doing an activity such as walking.
- Day programs/seniors programs: These provide social interactions for the person as well as respite for the caregiver.[i]
Visit alzheimer.ca for more information about community resources and support groups.
Conclusion
Caring for a loved one with Alzheimer’s Disease is a challenging yet vital role, requiring both emotional resilience and physical preparation. As Alzheimer’s progresses, caregivers are often faced with increasing demands to assist with daily activities, mobility, and personal care.
The essential techniques outlined in this blog, such as safe bed mobility, transfers, and sit-to-stand movements, help to ensure that caregivers can provide effective support without risking their own health.
Physiotherapists can offer invaluable education and guidance to caregivers, from teaching proper body mechanics to introducing assistive devices that can ease the strain of caregiving. However, caregivers must also prioritize their well-being by recognizing signs of burnout and incorporating self-care practices, including regular stretching and strengthening exercises, into their routines.
By equipping caregivers with the knowledge and skills to safely assist individuals with Alzheimer’s, we can enhance the quality of care provided while reducing the risk of injury and caregiver fatigue.
If you are a caregiver seeking additional support, consider booking a consultation call with one of our physiotherapists to discuss how physiotherapy can help provide personalized strategies and resources to meet your unique needs.
References
Written by
