1. ALWAYS approach an Alz. person from the front.

A little known fact about Alz. disease revolves around the peripheral vision in an Alz. person. Few people are aware that as the disease progresses, the peripheral vision of an Alz. victim digresses. By stage 6, most Alz people have lost or are at least beginning to lose this part of their vision. As a result, they have a greater risk of being caught off guard if someone approaches them from the side. Keep in mind if they are unaware of you, their "reaction" may range from being startled (which can make them fall) to striking out at a person they did not know was there. If you are looking for an Alz person and spot them PLEASE curb your natural impulse to spontaneously reach out and grab them. Instead, simply walk past them to a reasonable distance, turn around and approach slowly from the front. Once you have made eye contact, keep your voice friendly and give the appearance that you know the person. Address them by name, walking slowly towards them until you are within a range of where you can carefully assess the situation. Look at the persons demeanor. Look into their eyes. View their stance...their movements and behaviors. If they are calm, reach out your hand and encourage them to take it. If, as I said before, it is swatted away, remain at a safe distance and try to calm them down using a quiet gently voice.

2. Always keep the tone of your voice friendly.

As I have mentioned several times before, the tone of your voice is an important tool in dealing with an Alz. victim. As their ability to comprehend diminishes, they become very perceptive at reacting/responding to the tone of a voice. If they sense frustration, anger, or impatience, they are very apt to respond in kind. Moderating your voice so it is even and friendly, tells the person they have know need to fear you. A smile, a friendly gesture and a sense of calm can actually accomplish what words may fail to do....offer a sense of comfort and security to a very frightened person.

3. Avoid taking an Alz. person to any place that has a lot of activity going on.

As you might have guessed, Alz. victims react to the environment around them. So placing an already disoriented person in a room brimming with activity, is like offering gasoline to a pyromaniac...it's a very combustible situation. To much stimulation can actually act as an overload to their already weakened capacities and increase their sense of anxiety and agitation. To lessen these symptoms, choose a location carefully. Keep in mind a serene atmosphere is vital in keeping them calm, so be selective where you place them. A room away from the general hoopla of every day activities, is an ideal one. Someplace, anyplace that offers a sense of security and relaxation will help immensely. BUT, REMEMBER they need to be supervised constantly, because left unattended, they are likely to wander away and become lost again.

4. There are 2 types of Alz. victims and each type will respond differently.

Contrary to what most people believe, there are actually two types of Alz. victims and each has their own way of dealing with stressful situations. Those who develop Alz. on the left side of the brain tend to be more aggressive in nature, while those whose right side is affected, are much more passive. Now mind you, for the most part, these "features" are undetectable until they are forced to deal with a difficult situation. Then the features arise.

By far, the most difficult to deal with are those whose left brain is involved. I'm not referring so much to their combative nature, as I am to the way they deal with trying circumstances. You see, these individuals have a very profound mistrust of everyone. And their suspiciousness and paranoia leads them to believe they are never safe. Unfortunately, these symptoms make them much more difficult to locate when they wander away because unlike the passive Alz. victim, these individuals tend to hide because of their overwhelming paranoia. They will actively avoid anyone they believe to be looking for them by hiding in the backseats of car, in garages and behind bushes. When confronted they are usually belligerent, aggressive and combative. Careful handling is always the key to dealing with a confrontational Alz. victim. A slow approach, a friendly tone and a safe distance are your only tools. In these cases be prepared to spend a great deal of time reassuring these individuals because rushing the situation will only make matters worse.

On the other hand, a passive Alz. victim is the exact opposite. When they are confronted with situations beyond their comprehension, they simply withdraw. Neither confrontational, nor aggressive, on some occasions these people tend to try and find someone to help. They may approach strangers and ask to be taken home. They may wander for periods of time, and then stop and stay there. Most often, these Alz. victims tend to show their distress through weeping or repeating a key phrase like "oh dear, oh dear" . Some may show outward signs of disconcert by tugging at their hair, rubbing their hands together or aimlessly pacing. There is a general 'blankness' to their face and their eyes may seem vacant. Under extreme stress their words will be jumbled and nonsensical. When asked a question, such as "where are you going", they may point vaguely in a direction but give no specific clarification as to why they want to go "there". They may also begin repeating the same sentence over and over again such as "I want to go home", and yet NOT be able to tell you where home is. But unlike the above type of victim, these Alz. loved ones NEED assurance. They seek human contact and want to be certain they are safe. Comfort them as you would a small lost child because that's what they are. Hold their hand and reassure them a LOT that they are safe and have no need to worry.

Early Stage 5 responses:

Even in early stage 5, you will find that neither of these types of victims will be able to give clear, accurate information concerning most aspects of their lives. They may give you a phone number, but it's usually to a relative. They may go with you, but be unable to give you specific directions to take them home. The key thing to remember is... the more stress they feel, the more disjointed their conversations will be. They may describe a house they lived in 40 years ago. Or they may say, "I live in a white house with some lady/man". Do you see what I mean? How specific is that answer? They replied to your question but gave no definite information. You only know that they MIGHT live in a white house and that chances are, there is a family member or some form of care supervisor that lives with them. They may even be able to tell you the persons first name such as Mary or Tom but not the last.

But there is 'good news' in the above example. If they live with someone, there's a good chance the caregiver knows the person is missing, so in all likelihood you will be contacted about a lost Alz. victim. If not, begin calling Police Stations, Hospitals, Nursing Homes, Assisted Living Facilities, Adult Daycare Centers and even Senior Centers.

5. Don't be afraid to 'play act' if the situation is called for.

As I said before an Alz. victim is prone to hallucinations and misconceptions. And although their reality may not be accurate, what they are experiencing is REAL to them. Unfortunately to most people, these delusions are very disconcerting and the common response is to 'correct' the misconception. They try to re-orientate the person or find themselves making comments like; "you know that's not true". But to the Alz person it IS. What they are saying they honestly believe and are neither fabricating nor being untruthful. To be corrected or called a liar is very upsetting to them because they are certain it is factual.

How do deal with misconceptions: a. Listen closely to what they are saying. b. Can you distinguish any truth in their comments? (i.e. "I live over on Elm Street but I had to leave because a bear was in the house.") c. How are they responding to this misconception? Does it cause them distress or anxiety? Or is it something remarked upon off handedly?

To deal with misconceptions you must first judge the whole picture by paying close attention not only to the remarks being given but also to how the person is responding to their own comments. On one hand, a misconception may not prompt any sort of emotional upheaval at all. "I am waiting for my dad to come and get me". But on the other, it may cause a great deal of anxiety, "I had to escape because men were after me".

Let's begin by looking at the off handed comment from above. What would be the correct response to the "my dads coming to get me", remark? Would you reply:

a. "Are you crazy? Your dad would have to be 150 to still be alive". b. "Your dad's coming to get you? Are you nuts!" c. "So what time is he picking you up?"

If you picked C, you've selected the closest to being right, but even that is wrong. The right response to a comment such as above, is to give a noncommittal answer. Something like; "Oh that's great!" Would you like to come inside and wait for him? We'll be able to see him through the window." Or if your inside it would be; "Well he might be running late, why not sit down. Would you like a cup of coffee?"

Once they are in a safe area the next step is diversion. Try to get them thinking about something else while playing along with what they are saying. For instance: " So, what does your dad do for a living? And what sort of job do you have? " By asking these types of questions, you are diverting them into a different thought pattern. And since these types of misconceptions are harmless there's no reason not to go along with it.

However, when the delusion causes anxiety, different tools come into play. And your first step is to alleviate as much anxiety as possible. Many times it isn't so much what they are seeing that needs validating, but the feeling of fear or apprehension that results from it. And THAT is what you need to focus on.

First, keep in mind this person believes they were being chased. And to him or her that's extremely frightening. Now I know the common response would be to reassure the person they are safe. But reassurance is not what they want or need. What they seek...is a validation of their fear.

At this point, forget about reassurance and focus on the underlying fear this person is feeling. Keep your comments targeted to their emotional state by validating their fear. Even something as simple as "Gosh, no wonder why you ran. I'd be scared too", will be enough to substantiate what they are feeling. And it's only then, can you begin to reassure them of their safety.

So what's the bottom line? When reality is altered in an Alz. person, it doesn't matter what is real or what is not. Misconceptions are a daily fact of living and playing along (in most circumstances), is neither wrong nor a lie.

6. Distraction and music may divert unpleasant behaviors.

Diversion is one of the tools caregivers use everyday. It works not only in altering the Alz. victims thought pattern but it can actually be used to calm a fidgety person down. Often times an Alz. person falls into what I call a repetitious rut. They begin doing something over and over again or they may ask the same question repeatedly. So to curb these behaviors you have to distract.

So what can you use in your office or area as a means of diversion? Just about anything. Have them push in chairs, straighten papers, separate pens from pencils, untangle rubber bands or paper clips. Anything that will keep their hands busy and divert their mind into thinking about something other than their repetitious thought.

Music is another means of distraction especially for an anxious sundowning Alz. person. As most people know music soothes the soul and that's certainly true in the cases of Alz. Music is therapy to them and soft tranquil music can calm even the most apprehensive of Alz. people. So if all else fails, try putting on some low music in a quiet room.

Another method is rememinicing techniques. Use your own memories to begin a conversation that is neither pressuring or thought provoking. Distraction really is an easy thing to accomplish if you use your own creativity and imagination.