A. Home care for the elderly with dementia
1. Emotional support: It is important to respect the patient’s personality and never hurt the patient’s self-esteem. Should often use touching action and kind words, give the patient care and affection. The tone of voice should be lowered when talking, the attitude should be kind, spit out clearly and slowly, do not laugh at the patient, and do not easily deny the patient’s request.
2.Strengthen the protection to prevent accidents: do 24-hour company for those who are seriously ill, and strengthen the care for the light ones during the time when the patient is most active. Patients should not go out alone to avoid getting lost. Put a safety card with the patient’s name, age, home address, contact number and the disease the patient is suffering from in the patient’s pocket. In addition, there should be safety measures at home, such as wearing non-slip soft-soled shoes, installing handrails in bathrooms and bathrooms, and adding bed stalls to the bedside of bedridden patients.
3, daily life, reasonable arrangements: the patient’s diet should be rich and varied, regular and quantitative, with high protein, low fat, high fiber, easy to digest soft food.
4.Other: For patients with advanced or severe dementia, their daily living care is more important, they should be turned and patted regularly to prevent bed sores; for patients with speech difficulties or ambiguity, they need to communicate through eyes or gestures; for those who are slow or struggling to eat, they should be fed slowly and avoid choking or choking as much as possible; for those who really cannot eat, it is better to put down the nasal feeding tube.
Family members should always supervise and assist the patient to do good personal hygiene. Let them do some simple chores such as making tea, washing dishes, sweeping the floor, shopping, etc. to establish new conditioned reflexes in the mind. Make full use of watching TV, listening to music, reading newspapers and magazines to give them external stimulation in audio-visual aspect; often consciously let patients remember and judge to exercise their brain thinking activities.
For patients with abnormal behavior, repeated reinforcement training should be conducted. If the patient has the phenomenon of open defecation, the family should grasp the patient’s urination and defecation pattern, and regularly urge the patient to go to the toilet. Train the patient to have a regular life, the activity time is not too long, the surrounding environment should be relatively quiet; when the patient has too high or unreasonable demands, to discourage or distract their attention.
Serious patients should do a good job of oral care, as well as perineal and skin cleaning care. The patient should be turned, patted and tanned frequently, and ventilated regularly every day. In addition, give the patient some passive activities of the limb joints. Maintain the normal functional position of the limbs to prevent joint deformity and muscle atrophy.
II. Home intelligent rehabilitation training for the elderly with dementia
1.Model of intelligent rehabilitation therapy
Nowadays, there are two main models of dementia rehabilitation, namely: intellectual stimulation therapy (referred to as 3R therapy) and ABAB therapy model.
The 3R therapy mainly achieves intelligent rehabilitation through three parts: reminiscence, reality orientation and re-invigoration.
ABAB therapy, on the other hand, divides the intelligent rehabilitation time into four periods, and implements body perception, music and movement, and functional activities of the limbs, the three physical rehabilitation therapy training components, to patients within the four periods.
2.Commonly used intelligent training therapies
(1) Memory rehabilitation methods
Patients with Alzheimer’s disease have impaired recent memory, but most of their distant memory is still preserved. Through conscious and repeated memory training, the decline can be delayed and the recovery of intelligence can be promoted. These specific methods include.
①Instantaneous memory: The caregiver can recite a sequence of numbers out of order, starting with three digits and increasing one digit at a time. For example: 125, 2334,51498 …… After reciting the numbers, the patient can repeat them until he/she is unable to do so.
②Short-term memory: Give the patient several items, such as apples, rice bowls, cell phones, pens, etc., and then immediately put them away and ask him to recall what he just saw. The number of items can be increased gradually from small to large, and the viewing time can be from long to short.
(3) Long-term memory: From time to time, ask the patient to recall the names of relatives and friends at home, colleagues in the original unit, the contents of the TV he watched a few days ago, things that happened at home, etc.
(2) Attention rehabilitation methods
① Demonstration training: The trainer shows the patient the activity to be shown through various sensory methods and gives verbal cues so that the patient can focus on it. For example, if you play tai chi, let the patient see the stretching and smooth movements while explaining the action points in a subdued manner, so that the patient’s visual and auditory senses are mobilized to strengthen the training of attention.
(2) Classification training: The purpose is to improve the patient’s attention at different levels of difficulty. The operation is mostly in the form of paper and pencil exercises, requiring the patient to complete the prescribed pattern depiction according to the instructions, or to execute the appropriate action to the instructions in the tape or computer.
(3) Numeracy training
For example, the patient can divide chopsticks into two piles and ask the patient to compare which pile has more and which has less. Patients can also be asked to do some simple household consumption account calculations, such as going to the mall and buying some daily necessities, and then asking them to calculate how much each item cost, how much they spent in total, and how much money is left.
(4) Language training: For patients with Alzheimer’s disease, impaired language function is a big problem. Strategies and goals differ for different levels of impairment. For the very heavy ones, such as those with unclear pronunciation, teach them to pronounce simple words as clearly as possible, or show them visual objects, such as water glasses, and ask them to name them; for those who are very poor with words, teach them simple words for daily life and simple words for expressing ideas, and just accept them slowly. For simple conversation is okay, forget the words or words do not reach the meaning, family members may want to encourage the patient to speak more appropriately, do not be afraid to say wrong. In short, patients must be encouraged to communicate more, more expression, more understanding, etc., which is the key to try to repair language skills. The method and progress should be different from person to person and gradual.
(5) Other useful intellectual training
Intellectual activities are actually very rich in content, such as logical association, the ability to think flexibly, analysis and synthesis, understanding and expression, social adaptation, etc. Commonly used training methods are.
① Logical association, thinking flexibility training: from the children’s toys to find some beneficial intellectual toys, such as building blocks according to the drawings with a variety of shapes.
②Analysis and synthesis training: often let the patient make a generalization and classification of some pictures, objects and words. For example, take out some drawing cards used by children and ask patients to classify animals, plants, household items, etc. separately.
(3) Comprehension and expression training: Tell the patient about some things and ask him/her some questions to answer afterwards.
(6) Daily life activities training
The main content is to change clothes, food, housing and transportation, eating, using toilet, traveling, taking medicine, etc. For the training of cognitive function, try to let the patient complete various tasks alone. If the patient can complete the designated tasks alone, then ask the patient to shorten the time to complete the tasks as much as possible.
3. Problems to be noted in intelligent rehabilitation training and solutions
(1) Avoid or reduce the patient’s anxiety and dependence in the intelligent training. Patients often have anxiety because their memory function is diminished, they often cannot remember what they have learned, and they cannot recall the names of friends they know. At this time, the trainer is required to implement more encouragement and praise to the patient. At the same time, in order to avoid the patient’s dependence on the family’s careful care, the patient must be allowed to do whatever he/she can do by himself/herself during the training, so that the patient can gain confidence and satisfaction from it.
(2) Keep the living environment of patients with dementia warm and quiet, avoid complicating home furnishings, and avoid using confusing and complicated patterns on walls and floors.
(3) Maintain good communication with the patient on a regular basis. Encourage patients to express themselves more, let them know more information about the outside world as much as possible, cultivate and encourage them to participate in various interest activities, and do not keep them in a closed living environment.