Psychiatry - August 2008 - (Page 54)

upd int rf cl ] [ t h e a t e eo n a A e z h e i m e r ’ s ] reassure the caregiver, especially over time, that there is indeed “someone else” there to help. Another way a psychiatrist can assist the caregiver is by helping him or her find others who can provide needed knowledge and support. Caregivers who have previously cared for patients with AD can be uniquely helpful to other caregivers. They can make the difference between caregivers (and consequently the patients) not only surviving but to a relative degree thriving. Caregivers can provide emotional support to each other. Many former and current caregivers who have found ways to care for patients with AD successfully want to help other caregivers because they know how agonizing caring for tell her husband that it was his former company calling to tell him he should bathe. This worked. HELPING PATIENTS WITH END-STAGE AD In the last stages of AD, patients with this disease may need to reside in institutions. If this is the case, it is preferable that patients make this transition while they can still recognize their family members. This may help reduce feelings of terror they might otherwise feel due to not recognizing anyone or understanding where they are. Just as it is with caregivers, it is critical that the staff in an institution be aware that a patient’s quality of life is not only related to Psychiatrists should try to help the loved ones of patients with AD in every way they can, not only because the loved ones are important as individuals themselves, but also because the loved ones are important to patients with AD. a patient with AD can be and want to help others not experience the negative aspects of what they went through. I advise caregivers trying to find other caregivers not to stop trying until they find someone who not only “survived,” but survived with zest. Other caregivers may suggest approaches that greatly benefit not only the caregiver’s but the patient’s quality of life. For example, the spouse of one patient with AD was having difficulty getting her husband to bathe. After receiving feedback and suggestions from other caregivers, she came up with the following solution: Her husband had worked for the same company his entire adult life. His wife learned that she could go to another room and use her cell phone to call the home phone and then pick up the home phone and 54 Psychiatry 2008 [ A U G U S T ] illustrate the degree to which such meausures can and ideally should be carried out. The staff gave some of these patients a nontraditional “towel bath,” using a no-rinse soap and a warm, moist bath blanket, never leaving the patient uncovered. This caused these patients less discomfort and took less time to complete.28 Another example of the importance of staff interacting “socially” with a patient with AD is suggested by a particularly intriguing study. In this study, it was found that staff members were often better able to identify the occurrence of dyspnea in patients who were not able to adequately communicate compared to identifying pain in patients who were not able to adequately communicate. For this reason, staff members would give patients with dyspnea more attention because it was more easily recognized that the patients needed it, and so it is Afterall, the loved ones of a patient with AD will be the ones who come to visit the patient in the institution and are likely to be more caring toward the patient than anyone else. the degree of cognitive decline.1,3,4 An example of the benefits of social interaction with patients with AD involves a study on patients’ responses to staff who helped them shower. These patients seemed to become less agitated and less aggressive when staff took their time and were more caring during the bathing process, despite the fact that this type of bathing was more time consuming and therefore less efficient.3,28 Examples of the kinds of “person-centered” care these clinicians offered these patients theorized that patients with dypsnea did better because they received more positive attention from the staff than the patients who were experiencing pain.29,30 This brings us to the topic of treating pain in patients with AD. If (of course) a patient with AD shows signs of pain, the clinician should do all he or she can to relieve it.31,32 This may pose an exceptional problem, however, when providing pain relief poses serious adverse risks. Conventionally, clinicians tend to give pain relief more readily to

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Psychiatry - August 2008 Editor’s Message Editorial Advisory Board Contents Borderline Personality Disorder: Are Proliferative Symptoms Characteristic? Short-acting versus Long-acting Medications for the Treatment of ADHD Baby Stimuli and the Parent Brain: Functional Neuroimaging of the Neural Substrates of Parent-Infant Attachment These Boots Are Made for Stalking: Characteristics of Female Stalkers Managing Attention Deficit Hyperactivity Disorder in the Emergency Department Obstructive Sleep Apnea, Hypoxia, and Metabolic Syndrome in Psychiatric and Nonpsychiatric Settings Improving the Quality of Life in Patients with Alzheimer’s Disease The Process of Getting New Drugs to Market Journal Watch Classified Advertising Information for Authors

Psychiatry - August 2008

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