Caregiver Skills in Moderate, Mid Stage Alzheimer's

by Christine Kennard Health Professional

Alzheimer's disease can broadly be categorized in seven stages.
I have put together some tips to help you become a more effective caregiver
during the Moderate stage (5 and 6) of Alzheimer's.

First Big Rule: Caregivers Must Look After Themselves

You must care for yourself. Being a caregiver to someone with moderate, mid-stage Alzheimer's is very demanding. The brain of someone with Alzheimer's disease is becoming more and more damaged and their memory and behavior is a result of that damage. You have already had to adjust to the many changes that you are seeing in your loved one.
You may have given up many hopes and dreams for your life together. You now need to get support from friends, family, through your local chapter of the Alzheimer's Association, and from websites like OurAlzheimer's.

How to Give Support for Memory Difficulties in Moderate, Mid Stage Alzheimer's

Memory for recent events has probably disappeared by this stage, but longer term memory is often still intact. You can help the person by repeating information as often as necessary. Do not remind them that they keep forgetting things as it can be undermining and make them anxious. Be supportive. Allow the person to repeat stories, even if they tell you the same one over and over.

How to Maximize Language Skills in Moderate, Mid-Stage Alzheimer's

Remember that by this stage of Alzheimer's the person often finds it difficult to understand words. Be more precise and use more simple words. For example, as you hand them their meal say, 'here is your food' rather than, 'it is supper time'. Redirect the person to another conversation subject if they become anxious.

How to Help People with Moderate, Mid-Stage Alzheimer's Do Complex Tasks

  • Break down tasks into small steps. Give praise as they join in or complete tasks.

  • Eliminate distracting sounds so they do not get confused.

  • Talk in a calm, warm and friendly manner. Do not shout. Face them when you talk and use simple sentences.

  • Humor and jokes can lighten the load for you both and the person with Alzheimer's will often be more cooperative.

  • Try to encourage them to do as much as they can for themselves realizing that more and more they will need your help to do tasks.

  • If he/she becomes agitated or upset, move on to another task

Always keep in mind that it is devastating brain damage that is causing their problems. View uncooperative behavior as due to the disease, not something they are doing to annoy you. If you find yourself getting upset or angry, stop and
take yourself out of the room once you have made the environment safe. Return once you are calmer. Tell the person what you did and why. They may not understand too well, but is important that they get the chance to know you find things difficult at times too.

How to Provide Activities in Moderate, Mid-Stage Alzheimer's

During this stage the person becomes more self-centered. They can find it difficult to relate to their loved ones. Activities are often more effective on a one-to-one basis. As brain damage takes its toll, reflective activities become more difficult and can cause considerable anxiety as the person struggles to use their failing memory. Access to older memories means that some reminiscence is possible and enjoyable using old photographs and family DVDs.

Try listening to music and enjoy walks.
Modest gardening activities in which people with Alzheimer's disease can be encouraged to smell flowers and enjoy color, not only gives the day some structure, but also helps validate people as individuals. It can give purpose to a day, help with relaxation and promote sleep. It is important to keep the person with Alzheimer's as fit and healthy as possible. Move to another different activity if he/she becomes agitated.

Medications in Moderate, Mid-Stage Alzheimer's

There is no cure for Alzheimer's but there are drug treatments that can help with resulting behavioral problems. Cholinesterase inhibitors are most commonly prescribed in the mild to moderate stages of Alzheimer's disease. These include Aricept (donezepil HCL),
Exelon (rivastigmine) and Razadyne (galantamine). These medications postpone the worsening of symptoms for 6 to 12 months in about half the people who take them.

Memantine (Namenda) was approved in 2003 for treatment of moderate to severe Alzheimer's disease. It works by regulating the activity of glutamate, a messenger chemical involved in learning and memory. Improvement is often minimal but this drug is still worth trying.
Drugs may cause side effects and may interact with other medications. Your doctor may need to try different cholinesterase inhibitors until the most effective one is found. Medications for behavioral symptoms include:

  • Anxiolytics for anxiety. For example lorazepam (Ativan),

oxazepam (Serax).

  • Antidepressants for depression. For example paroxeine (Paxil),

sertraline (Zoloft), fluoxetine (Prozac)

  • Antipsychotic medications such as haloperidol (Haldol),
    quetiapine (Seroquel), olanzapine (Zyprexa), aripiprazole (Abilify)

  • Increasingly mood stabilizers, such as carbamazepine (Tegretol), and divalproex (Depakote) are also prescribed.

Christine Kennard
Meet Our Writer
Christine Kennard

Christine Kennard wrote about Alzheimer's for HealthCentral. She has many years of experience in private and public sector nursing care homes for people with dementia. She has worked in a variety of hospital, public and private health settings and specialized in community nursing. Christine is qualified in group analytic psychotherapy, is registered in general and mental health nursing and has a Masters degree.