Photo of the brain showing functions/areas mainly and progressively affected in AD.

Photo of the brain showing functions/areas mainly and progressively affected in AD. 

Therefore, stimulation of the person affected is important, without overstimulation of course, in order to keep the brain active delaying this way its progressive impairment therefore improving/reinforcing quality of life.  In addition to providing enjoyement in the person's daily life. 

Ideally, in association with treatments to reduce psycho&behavioral disorders and physical exercices to keep muscular strenght. Caregivers (Pro and/or Family) have an important role to play from supervision only to necessary assitance. 

Support groups (through phone/meeting/net) may be helpful to mitigate loneliness, find support, share happiness moments and also tips worth trying in daily life.

                       Double click on the picture to enlarge it.

"STUDY ON PERCEPTIONS TOWARDS HUMAN RIGHTS OF OLDER PERSONS", INDIA, 2013.

"The state of hospitals and clinics across the country is not standardized. 

While in urban India with the right kind of resources an elderly person can get good healthcare facilities the same is not the case for a majority of the population as the infrastructure and sensitivity towards older persons is lacking on the medical front. 

Coupled with the already existing medical issues for older persons, lack of infrastructure and sensitization of hospital staff and clinics towards the elderly."....

Source: "STUDY ON PERCEPTIONS TOWARDS HUMAN RIGHTS OF OLDER PERSONS" 

Agewell Foundation Research and Advocacy Centre.
(In Special Consultative Status with the ECOSOC at United Nations since 2011)

Link to Pdf and english version: http://www.agewellfoundation.org/perceptions_towards_older_Persons_July_2013.pdf

"Sundowner’s Syndrome"

"Sundowner’s Syndrome is the name given to an ailment that causes symptoms of confusion after “sundown.” 

These symptoms appear in people who suffer from Alzheimer’s Disease or other forms of dementia. Not all patients who suffer from dementia or Alzheimer’s exhibit Sundowner’s symptoms, however. 

Conversely, some people exhibit symptoms of dementia all day which grow worse in the late afternoon and evening, while others may exhibit no symptoms at all until the sun goes down."...

link: http://sundownerfacts.com/sundowners-syndrome/

Principles to try to follow every day in AD caring journey:

                     Double click on the pictures to enlarge them

Dementia National Strategy as per France (english version): 44 measures.

44 measures in order to fight Alzheimer’s disease and related disorders

Alzheimer’s disease and related disorders progress inexorably as people age : over 85 years old, 1 woman out of 4 and 1 man out of 5 suffer from them. Faced with this major scientifical, medical and social challenge, the President of the French Republic launched on 1rst february 2008 the "plan Alzheimer 2008-2012". Centered on the person with the disease and his or her family helpers, the plan aims at unprecedently developping research, facilitating a timely diagnosis and taking a better care of the person and his or her helpers.

National plan for Alzheimer 2008-2012:

Improving quality of life for patients and carers

Objective 1: Increasing support for carers

• Measure 1: Developing and diversifying respite structures
• Measure 2: Consolidating rights and training for carers
• Measure 3: Improving health monitoring for family carers

Objective 2: Strengthening coordination between all actors involved

• Measure n°4: Quality labelling throughout the country for "single points of contact", the "Maisons pour l’Autonomie et l’Intégration des malades Alzheimer" (MAIA)
• Measure n°5: Establishing "coordinators" throughout the country

Objective 3: Enabling patients and their families to choose support at home

• Measure n°6: Reinforcing support at home, advocating services by trained staff
• Measure n°7: Improving support at home using new technologies

Objective 4: Improving access to diagnosis and care pathways

• Measure n°8: Preparing and implementing a system for giving the diagnosis and providing counselling
• Measure n°9: Experimenting new payment terms for health professionals
• Measure n°10: Creating an Alzheimer’s disease information card for each patient
• Measure n°11: Creating memory units in areas that are not covered
• Measure n°12: Creating "memory resource and research centres" in areas that are not covered
• Measure n°13: Reinforcing the very active memory units
• Measure n°14: Monitoring drug-related iatrogenic accidents
• Measure n°15: Improving correct use of drugs

Objective 5: Improving residential care for better quality of life for Alzheimer’s disease sufferers

• Measure n°16: Creating specific units for patients suffering from behavioural problems within EHPADs
• Measure n°17: Creating specialized units within health care rehabilitation and follow-up (SSR) departments for Alzheimer’s patients
• Measure n°18: Accommodation for young patients
• Measure n°19: Identifying a national reference centre for young Alzheimer’s patients

Objective 6: Recognising skills and developing training for health professionals

• Measure n°20: A specific career and skills development plan for Alzheimer’s disease

Knowledge for action

Objective n°7: Making unprecedented efforts in research

• Measure n°21: Creating a foundation for scientific cooperation to stimulate and coordinate scientific research
• Measure n°22: Developing clinical research of Alzheimer’s disease and improving evaluation of non-drug therapies
• Measure n°23: Doctoral and post-doctoral grants
• Measure n°24: New assistant surgeon and hospital teaching assistant positions
• Measure n°25: Research in human and social sciences
• Measure n°26: Support for research groups working on innovative approaches
• Measure n°27: Support for methodological research groups in human and social sciences
• Measure n°28: Creation of a body of research in automatic image processing
• Measure n°29: Studying large patient populations (cohorts) with long-term monitoring
• Measure n°30: High-speed genotyping
• Measure n°31: Exploiting the genome sequencing of the microcebe
• Measure n°32: Training in clinical epidemiology
• Measure n°33: Developing links between public research and industry

Objective n°8: Organising epidemiological surveillance and follow up

• Measure n°34: Setting up epidemiological surveillance and follow up

Mobilising around a social issue

Objective n°9: Providing information for general public awareness

• Measure n°35: Setting up a telephone helpline and a website for information and local advice
• Measure n°36: Holding regional conferences to support the implementation of the plan
• Measure n°37: Studying disease knowledge and attitudes

Objective n°10: Promoting ethical considerations and an ethical approach

• Measure n°38: Creating a space for ethical thought about Alzheimer’s disease
• Measure n°39: Launching a discussion about the legal status of Alzheimer’s patients in institutions
• Measure n°40: Organising regular meetings focusing on the autonomy of people suffering from Alzheimer’s disease
• Measure n°41: Informing patients and their families about trials implemented in France

Objective n°11: Making Alzheimer’s disease a European priority

• Measure n°42: Making the fight against Alzheimer’s disease a priority for the European Union during the French presidency
• Measure n°43: Publicizing and promoting research across Europe
• Measure n°44: Holding a European conference in autumn 2008

• Measure S1 : Studying opinion and attitude about Alzheimer’s disease and the impact of the plan among patients and carers

Source: http://www.plan-alzheimer.gouv.fr/-44-measures-.html

Nursing Management of Dementia : NURSING CARE PLAN

VIII. NURSING CARE PLAN

A.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Therapeutic Needs	1. To All types of illness may be treated symptomatically reduce any types of infection 2. To recover from any infection 3. Help him to develop sense of security.	All types of illness may be treated symptomatically	1. Give medicines as prescribed. 2. Help the patient to express his physical complaints. 3. Give assurance that medicine will be provided in time.

B.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Physical needs Prevent from injuries	1. To help to avoid repeated injuries 2. To feel confident that environment is safe.	1. Plan safe and less congested environment . 2. Plan to keep few activities, no injuries to patient	1. Provide adequate furniture in the room. 2. Check no wires, tubes etc. are spread in room. 3. Electricity connections should be covered 4. Provide the same physical setup. 5. Any change in the room should inform the patient. 6. Provide a bell. 7. Adequate light. 8. Pleasant and quite environment.	Moves in the room with confidence.
Promote Communication	1. To enhance self concept. 2. Develop sense of satisfaction of interacting with others. 3. Feel accepted	1. Spend time with patients. 2. Selective Communication	1. Approach in a slow calm manner. 2. Observe non-verbal cues. 3. face the patient 4. Talk gently 5. Give simple clear message him to talk    . 6. Listen with respect 70 Repeat instruction frequently	Express happiness that, he is able to convey message clearly

Nursing Needs	Goals	Planning	Implementation	Evaluation
Reduce disorientation	1. To help him feel comfortable and decreased confusion 2. To help in regular activities 3. To feel secure and decreased restless.	1. Re-orientation 2. Clear communication	1. Orient him to time, place of persons with help of a clock calendar and physical setup. 2.  Call him by his name. 3. Repeat the routine activity 4. Avoid argument 5. Speak slowly, clearly  in simple sentence. 6. Convey warmth and concern. 7. Touch him to provide a sense of security. 8. Respond to his question 9. Encourage him to  speak clearly, not to mumble words 10. created comfortable environment without stress or hurry	1. He looks less confused 2. Feels comfortable in the setting
Help in personal hygiene	1. To help patient to feel fresh 2. Develop sense of well being 3. Habit of cleanliness 4. Prevent infection 5. Feel accepted	1. Setup a routine plan  out activities for regular bowel and bladder habits	1. Help him to brush and take bath 2.  Help him to clean his back 3.  Give message at the back to prevent bed sore. 4. Change position 5. Observe skin for injuries, bruising or abrasion 6. If in continence change the dress put deodorant to prevent odor 7. If constipation provide laxatives 8.   Step by step directions to be given 9. Don’t be in hurry 10. Encourage to comb, shave etc.	Patient brush his teeth, take bath, combs hair trice to tries to be self sufficient.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Help to adjust with perceptual change	1. To reduce anxiety 2. To adjust perceptual deprivation 3. To improve in his sensation 4. To decreased irritability	1. Patients are very confused and had anxiety. 2. Not able to recognize places 3. Help to reduce anxiety and confusion 4. Patient will be disturbed with hallucination. Help him to cop up	1. Re-orient the place and allow him to touch and feel familiarity . 2.Allow him to smell his old perfume 3. Prevent him from burns. Lack of sensitivity may cause burn. 4. Speak very clearly to patient. 5. Help the relatives to understand that changes is due to disease.	Patients feel less restless.
Help to adjust in alteration in memory of attention	1. Help the patient to increased attention span. 2.  To adjust memory changes.	1. Patients get irritated unable to recall, recent events. 2. Feels inadequate in front of relative and friends.	1. Make them to understand change is due to disease. 2. Tell the relatives not to get irritated if he were forget to inform important messages. 3. Switch an old songs  or show old photographs to stimulated memory. 4. Provide activities of his own choice 5. Give appreciation for complete work 6. Provide opportunity to do the tasks, which he had been doing for many years	1. The patients shows concentration and efficiency in his works 2. Feels comfortable with old things.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Help to adjust with perceptual change	1. To reduce anxiety 2. To adjust perceptual deprivation 3. To improve in his sensation 4. To decreased irritability	1. Patients are very confused and had anxiety. 2. Not able to recognize places 3. Help to reduce anxiety and confusion 4. Patient will be disturbed with hallucination. Help him to cop up	1. Re-orient the place and allow him to touch and feel familiarity . 2.Allow him to smell his old perfume 3. Prevent him from burns. Lack of sensitivity may cause burn. 4. Speak very clearly to patient. 5. Help the relatives to understand that changes is due to disease.	Patients feel less restless.
Help to adjust in alteration in memory of attention	1. Help the patient to increased attention span. 2.  To adjust memory changes.	1. Patients get irritated unable to recall, recent events. 2. Feels inadequate in front of relative and friends.	1. Make them to understand change is due to disease. 2. Tell the relatives not to get irritated if he were forget to inform important messages. 3. Switch an old songs  or show old photographs to stimulated memory. 4. Provide activities of his own choice 5. Give appreciation for complete work 6. Provide opportunity to do the tasks, which he had been doing for many years	1. The patients shows concentration and efficiency in his works 2. Feels comfortable with old things.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Help to adjust with perceptual change	1. To reduce anxiety 2. To adjust perceptual deprivation 3. To improve in his sensation 4. To decreased irritability	1. Patients are very confused and had anxiety. 2. Not able to recognize places 3. Help to reduce anxiety and confusion 4. Patient will be disturbed with hallucination. Help him to cop up	1. Re-orient the place and allow him to touch and feel familiarity . 2.Allow him to smell his old perfume 3. Prevent him from burns. Lack of sensitivity may cause burn. 4. Speak very clearly to patient. 5. Help the relatives to understand that changes is due to disease.	Patients feel less restless.
Help to adjust in alteration in memory of attention	1. Help the patient to increased attention span. 2.  To adjust memory changes.	1. Patients get irritated unable to recall, recent events. 2. Feels inadequate in front of relative and friends.	1. Make them to understand change is due to disease. 2. Tell the relatives not to get irritated if he were forget to inform important messages. 3. Switch an old songs  or show old photographs to stimulated memory. 4. Provide activities of his own choice 5. Give appreciation for complete work 6. Provide opportunity to do the tasks, which he had been doing for many years	1. The patients shows concentration and efficiency in his works 2. Feels comfortable with old things.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Nutritional need	1. To build general health 2. To make him to take regular meals. 3. Build up health	1. May take small quantity for fear of in continence 2.. Soft, easily digestible food.	1. Ask his likes and dislikes. 2. Soft and frequent meals. 3. Don’t scold him, if he has messed up 4. don’t make him to hurry up 5. Provide roughage and green leafy vegetable.	Patient enjoys soft meals.
Improve sleep	1. To reduce loneliness and depression at height 2. To feel fresh 3. Participate in day activities. 4. Get reduce fatigued	1. Planning sleep schedule. 2. A calm and quite environment	1. Discourage day time sleep. 2. Keep him busy with activities 3. Encourage warm water bath at night 4. Keep the room calm. 5. Give bath massage 6. Allow him to read books in he interested 7. Provide warm milk	Sleep for long hours at night

C.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Psychological needs	1. To reducing the feelings of isolation. 2. To develop sense of belongingness 3. Enhance self concept	1. Feels alien among his own 2. Likes to participate in activities 3. Provide an attitude of concern	1. Call him by his name. 2.Tell the relatives to visit 3. Encourage activities 4. Actively listen to his past experience 5.Listen him with respect 6.Encourage visit by children	Feel satisfied Talking to others

D.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Recreational needs	1. To decrease social isolation 2. To spend time productively 3.To enjoy life 4. Feel useful for family members	1. Help in diverting patients mind 2. Hobbies of his own, in which some productive outcome is possible	1. Tell children to pay with patients, simple games. 2. Provide knitting which she enjoys. 3. Read story for children. 4. TV. program of his choice. 5. Encourage to interact with his own group	Patients enjoys life and feels he is useful for family members.

E.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Spiritual needs	1. To help him to follow his routine 2. To reduce distress and despair.	1. Help him to maintain their rituals 2. Help them to adjust	1. Allow the patient to attend his regular prayers. 2. Don’t get irritated with extra time spent by patient. 3. Graduals help him to reduce the time. 4. Provide religious books. Videos and cassettes.	The patient says “ Now I am not able to pray for long because I get tired”.

F.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Discharge plan	1. To help him to be self sufficient. 2. To cope with changes due to illness	1. Depends on family support. 2. Discuss with family 3. To develop realistic goal towards patients recovery	1. Encourage family to talk about problems they have to face at home. 2. discuss the plan of care at home. 3. Explain the needs to make physical and social adjustment 4. Educate patient’s relatives for after care help from various agencies. 5. Importance of follow-up care	Relative of patients get prepared to adjust at home.

Source: http://nursingplanet.com/dementia/dementia_nursing_care_plan.html

Video: What is Alzheimer's disease? (in english)