Task Strategies & Coping Mechanisims Delay Institutionalizing

Based on a three-year study reported in the Gerontologist Magazine:

The ability to sustain care at home over the course of Alzheimer's Disease depends on how well caregivers implement effective strategies to cope with the complexity of caring for someone with dementia day to day.

Research suggests that the coping mechanisms used by caregivers should be based on a framework of knowledge regarding the disease process. This three-year study examined three types of caregiver coping strategies - the use of criticism, encouragement and active management.

>Criticism: “I threatened my family member with undesirable consequences if they did not cooperate or I yelled at them when undesirable behaviors occurred."

>Active Management: “I tried to do as many things for my family member as I can because they are not capable anymore."

>Encouragement: “I tried to help my family member look on the bright side of things."

What the researchers found was that the use of criticism type strategies contributed greatly to the lack of well being of both the caregiver and the family member and also seemed to have a direct correlation to earlier long term placement in a skilled nursing facility as compared to the other two groups.

Active Management strategies contributed to the family member’s loss of independence and an increase in caregiver burnout and stress. Encouragement strategies were credited with a decrease in the caregivers desire to institutionalize their family member and a decrease in caregiver stress.

Caregivers who followed the encouragement methods demonstrated the following consistently:

> Adjustment to the environment to simplify their family member’s experience. Example: Remove or pack away most of their family members clothing - leaving limited choices in their closet and dressers. The clothing they did leave was of similar style and color. The result is that their family member is able to dress themselves easily.

>Assigning simplified home chores to the family member to keep them occupied, expend energy and increase self esteem. Examples include folding laundry, sweeping, sorting silverware, and washing dishes.

>Creating an orientation area in the home that has a calendar, clock, a place for glasses, hearing aids, pens, reminder notes on a cork board and any other helpful items.

>Leaving lights on in the bathroom to encourage the family member to use it

>Use of disposable adult incontinence products as the need arises

>Use of finger foods to avoid having to correct table manners. (Sandwiches, tater tots, cut fruit, chicken fingers, cut vegetables, etc.)

>Use of distraction when their family member was becoming upset

Caregivers who used Active Management caused their family members to become totally dependent on the caregiver. Their family members were capable of successfully completing ADL's (dressing, bathing, hygiene, etc.) at the beginning of the study, but because they were not allowed or encouraged to practice these skills, they lost them much earlier in the disease process. This created increased stress on their caregiver, resulting in caregiver burnout, exhaustion and earlier institutionalization of the family member.

Similarly, Criticism type strategies caused the family members loss of self esteem, causing them to no longer participate in their own ADL's. This type of strategy also caused an increase in aggressive behaviors toward their caregivers (both verbal and physical) resulting in injury and early institutionalization.

Conclusion to this study strongly suggests that caregivers of persons with a memory impairing illness educate themselves to alternate strategies to manage their family members care needs. Doing so will decrease upsetting behaviors, decrease caregiver stress, increase or maintain family members' independence for a longer period of time and postpone or prevent the need for long term nursing home placement.

For more information regarding caregiver tips and support strategies, contact the Alzheimer's Association at (716) 626-0600.

For information regarding ElderWood Senior Care, please contact us at (716) 633-3900.