No one wants to move to a nursing home or put an aging parent in one. Yet, families may not have a choice when Dad loses a lot of weight because he lives alone and doesn’t eat well, or when he becomes depressed and forgetful. The nursing home may be the only place to care for him.
It happened to my family. We knew Dad didn’t want to go, but his dementia severely affected his ability to care for himself. It first started with problems dressing himself, followed by incontinence and, lastly, problems with his mobility, making transferring him even from his bed to a chair nearly impossible. Watching a parent slip slowly down the rabbit hole is frightening, and there’s nothing anyone can do about it.
The doctors told us that Alzheimer’s disease can cause deterioration in his capacity to do day-to-day living activities (ADLs), as well as the loss of cognitive function and behavioral changes. My Dad’s decline in everyday functioning increasingly became a burden on the family which led to a nursing home placement.
ADLs, activities involving health and hygiene, are the things we do on a regular basis to safeguard our health and well-being, and many of us take them for granted until we can no longer accomplish them. These instrumental activities are the ones that allow a person to perform complex skills to live independently. Here are some examples:
Primary activities of living
- Transferring – the ability to get out of bed or a chair
- Walking (even with the aid of a cane or walker)
Instrumental activities of living
- Food preparation
- Housekeeping and laundry
- Managing finances
- Use of the telephone
- Taking medication
- Using public transit or driving a car
The medical team measured Dad’s ability to perform these activities to assess his functional ability. They used tools called the Katz ADL Scale and the Lawton IADL Scale to determine the level of care he needed.
As his dementia progressed, there was a continual decline of abilities until the performance deteriorated to the point of ill-health. His body, not just the mind, was affected by the disease. He lost motor control. It was hard to watch him lose the independence he treasured, and it was very frustrating and depressing for him to realize that this was happening.
That’s when irritability, anger, aggression, and withdrawal set in. The family believed these behaviors were the result of his recognition that he couldn’t take care of himself. We tried everything to help him regain some skills but, unfortunately, the deterioration did not reverse. The doctor assured us that it was the nature of dementia, but we continued to encourage him to attend the therapies (brain cognition and memory training, for example) in hopes of delaying the effects. They did help make daily activities a bit easier, or at least do-able, for a short time. Our goal for Dad was to improve his functioning and independence that made him feel more productive in the end.
For families, safety should be the first concern when caring for a relative with a disability. Don’t take for granted that a loved one can perform everyday tasks like you. Remember that a knife can cut fingers as well as vegetables, and Alzheimer’s-proofing is similar to child-proofing a home.
Keep a watchful eye for a sign that points to their need for more care. Look out for unkempt hair and grooming, loss of weight, incontinence issues, and issues with paying bills. It’s hard to admit that a parent can decline so rapidly, but your awareness will keep a parent safe and healthy. Don’t jump to conclusions, and always consult with the parent’s physician for appropriate steps to take on their behalf.
Carol Marak contributes researched articles for the senior living and healthcare market. She advocates for older adults and family caregivers by writing on tough topics like chronic health issues, senior care, and housing. Find Carol’s work at AssistedLivingFacilities.org and SeniorCare.com. Find her on LinkedIn and at Carol@SeniorCare.com.