Mid-stage is when this debilitating disease really begins to affect your loved one's life on a more significant level, and can last anywhere from two years to a decade or longer. While you and your family may have been able to hide the diagnosis from those around you up until this point, you will probably not be able to any longer. The more benign issues of the early stage, such as memory problems and mild confusion, transform into much more challenging symptoms; and it is at this point where the real caregiving often begins. Three of the most common issues people deal with in this stage are hallucinations and illusions, change in sleeping patterns and incontinence, and here are some tips to help manage them.
Hallucinations
People with Alzheimer's disease can experience hallucinations that range from harmless to terrifying. This can be very difficult for a caregiver to deal with, and it may seem like it makes sense to try and explain that what the person is seeing is not real. But, the ability to reason has been severely compromised, and this will just not work. What they are seeing is very real to them, and trying to deny this will make everything much worse. You will do better to just work with the hallucination. If your loved one sees something on the ground that is not really there, say that you picked it up; if he thinks the room is on fire, tell him you called the fire department and they are coming to take care of it. There is no way to make this symptom ‘'go away.'' Your loved one will keep seeing these things, and you are not doing any harm by going along with it.
Illusions are also common in mid-stage Alzheimer's disease. Unlike a hallucination, where the person is seeing something that is not there, illusions are seeing one thing and thinking it is something else. For example, your loved one may see that box on the ground as a cat. If possible, it is okay to show the person what the object actually is, but if she begins to become agitated, just go along with what she says.
If hallucinations are becoming a serious problem, talk to a doctor about medications. On a related note, certain medications may cause hallucinations, so if this behavior coincides with having just started a new medicine, make sure to talk to your doctor—a change in prescription may help solve the problem.
Sleeping Problems
One of the most challenging issues in caregiving for mid-stage Alzheimer's is the change in sleeping patterns because it inevitably affects the caregiver's amount and quality of sleep. This job is hard enough, and throwing sleep deprivation into the mix, can make it seem impossible. Getting into a pattern of sleeping a lot during the day and staying up all night is very common. Establishing a daily routine offers many benefits for someone with Alzheimer's disease, with promoting normal sleeping patterns being high on the list. Exposure to sunlight is also very important since it naturally regulates the sleeping cycle—open all the curtains and blinds and let that light pour in. If lack of sunlight is a problem in your area, look into buying lamps that mimic natural lighting. Regular physical activity has been known to help Alzheimer's patients sleep more soundly, but avoid exercise at least four hours before bedtime. If your loved one is on a cholinesterase inhibitor, do not administer the medicine before she is set to go to sleep. Use caution with sleeping medications—they may worsen confusion and increase the risk of falls. If your loved one does need a nap during the day, make sure it is not too late, and steer him towards the couch or recliner rather than his bed. A set bedtime routine may also help.
Incontinence
Incontinence is one of the more unpleasant aspects for caregivers of mid-stage Alzheimer's patients. While it may be hard, it is important to stay calm. Not only will this prevent your loved one from getting agitated, it can also soothe some of the embarrassment she is likely to feel. Bladder issues will come first, while the inability to control bowel movements typically comes much later. Establishing a routine is a good first step, and will especially come in handy as the disease progresses and your loved one may no longer recognize the need to use the bathroom. Many health care experts recommend toileting first thing in the morning, every two hours throughout the day and then again before bed. Signs your loved one may need to use the bathroom include fidgeting, pulling at their clothing or wandering.
There are several type of incontinent products you can purchase. Pull down diapers are good for people who are still able to move around, while adult diapers are a better choice for the bedridden. For men, you can purchase male guards, which can catch urine. Once your loved one starts experiencing bladder problems, keeping the area clean is of paramount importance to prevent infection, irritation and skin break down. Making it through the night without an accident is rare, and it may be wise to invest in products to make clean up easier, such as waterproof mattress covers and bed pads—cloth or disposable.
