The 36-hour Day

by Mace, Nancy L.; Rabins, Peter V.

• ISBN13: 9780801885082
• ISBN10: 0801885086
• Edition: 4th
• Format: Hardcover
• Copyright: 2006-09-27
• Publisher: Johns Hopkins Univ Pr

Summary

Revised in 2006 for its twenty-fifth anniversary, this best-selling book is the "bible" for families caring for people with Alzheimer disease, offering comfort and support to millions worldwide. In addition to the practical and compassionate guidance that have made The 36-Hour Day invaluable to caregivers, the fourth edition is the only edition currently available that includes new information on medical research and the delivery of care. The new edition includes: -new information on diagnostic evaluation-resources for families and adult children who care for people with dementia-updated legal and financial information-the latest information on nursing homes and other communal living arrangements-new information on research, medications, and the biological causes and effects of dementia Also available in a large print edition Praise for The 36-Hour Day:

Author Biography

Nancy L. Mace, M.A., now retired, was a consultant to and a member of the board of directors of the Alzheimer's Association and an assistant in psychiatry and coordinator of the T. Rowe and Eleanor Price Teaching Service of the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. Peter V. Rabins, M.D., M.P.H., is a professor of psychiatry, with joint appointments in medicine, mental health, and health policy and management, co-director of the Division of Geriatric Psychiatry and Neuropsychiatry, and director of the T. Rowe and Eleanor Price Teaching Service of the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine.

Table of Contents

Foreword	xvii
Preface	xix
Acknowledgments	xxi
1 Dementia	1	(10)
What Is Dementia?	5	(2)
The Person with Dementia	7	(2)
Where Do You Go from Here?	9	(2)
2 Getting Medical Help for the Person with Dementia	11	(9)
The Evaluation of the Person with a Suspected Dementia	12	(3)
Finding Someone to Do an Evaluation	15	(1)
The Medical Treatment and Management of Dementia	16	(4)
The Physician	16	(1)
The Nurse	17	(1)
The Social Worker	18	(1)
The Geriatric Care Manager	19	(1)
The Pharmacist	19	(1)
3 Characteristic Behavioral Symptoms of Dementia	20	(24)
The Brain, Behavior, and Personality: Why People with Dementia Do the Things They Do	20	(3)
Caregiving: Some General Suggestions	23	(3)
Memory Problems	26	(1)
Overreacting, or Catastrophic Reactions	27	(4)
Combativeness	31	(1)
Problems with Speech and Communication	32	(6)
Problems the Person with Dementia Has in Making Himself Understood	33	(2)
Problems the Person with Dementia Has in Understanding Others	35	(3)
Loss of Coordination	38	(3)
Loss of Sense of Time	41	(1)
Symptoms That Are Better Sometimes and Worse at Other Times	42	(2)
4 Problems in Independent Living	44	(15)
Mild Cognitive Impairment	44	(2)
When a Person Must Give Up a Job	46	(1)
When a Person Can No Longer Manage Money	47	(1)
When a Person Can No Longer Drive Safely	48	(4)
When a Person Can No Longer Live Alone	52	(7)
When You Suspect That Someone Living Alone Is Getting Confused	52	(3)
What You Can Do	55	(1)
Moving to a New Residence	55	(4)
5 Problems Arising in Daily Care	59	(39)
Hazards to Watch For	59	(6)
In the House	60	(3)
Outdoors	63	(1)
In the Car	64	(1)
Highways and Parking Lots	64	(1)
Smoking	64	(1)
Hunting	65	(1)
Nutrition and Mealtimes	65	(9)
Meal Preparation	66	(1)
Mealtimes	66	(2)
Problem Eating Behaviors	68	(2)
Malnutrition	70	(1)
Weight Loss	70	(1)
Choking	71	(1)
When to Consider Tube Feeding	72	(2)
Exercise	74	(1)
Recreation	75	(3)
Meaningful Activity	78	(1)
Personal Hygiene	78	(7)
Bathing	80	(2)
Locating Care Supplies	82	(1)
Dressing	82	(1)
Grooming	83	(1)
Oral Hygiene	84	(1)
Incontinence (Wetting or Soiling)	85	(6)
Urinary Incontinence	85	(4)
Bowel Incontinence	89	(1)
Cleaning Up	89	(2)
Problems with Walking and Balance; Falling	91	(3)
Becoming Chairbound or Bedbound	92	(2)
Wheelchairs	94	(1)
Changes You Can Make at Home	94	(4)
Should Environments Be Cluttered or Bare?	96	(2)
6 Medical Problems	98	(21)
Pain	100	(1)
Falls and Injuries	100	(1)
Pressure Sores	101	(1)
Dehydration	101	(1)
Pneumonia	102	(1)
Constipation	102	(1)
Medications	103	(3)
Dental Problems	106	(1)
Vision Problems	107	(1)
Hearing Problems	108	(1)
Dizziness	109	(1)
Visiting the Doctor	109	(1)
If the Ill Person Must Enter the Hospital	110	(1)
Seizures, Fits, or Convulsions	111	(2)
Jerking Movements (Myoclonus)	113	(1)
The Death of the Person with Dementia	113	(6)
The Cause of Death	113	(1)
Dying at Home	114	(1)
Hospice	114	(1)
Dying in the Hospital or Nursing Home	115	(1)
When Should Treatment End?	115	(1)
What Kind of Care Can Be Given at the End of Life?	116	(3)
7 Behavioral Symptoms of Dementia	119	(30)
The Six R's of Behavior Management	119	(2)
Concealing Memory Loss	121	(1)
Wandering	122	(8)
Reasons That People Wander	122	(2)
The Management of Wandering	124	(6)
Sleep Disturbances and Night Wandering	130	(3)
Worsening in the Evening ("Sundowning")	133	(1)
Losing, Hoarding, or Hiding Things	134	(1)
Rummaging in Drawers and Closets	135	(1)
Inappropriate Sexual Behavior	135	(2)
Repeating the Question	137	(1)
Repetitious Actions	138	(1)
Distractibility	139	(1)
Clinging or Persistently Following You Around	139	(1)
Complaints and Insults	140	(3)
Taking Things	143	(1)
Forgetting Telephone Calls	143	(1)
Demands	144	(2)
Stubbornness and Uncooperativeness	146	(1)
When the Person with Dementia Insults the Sitter	146	(2)
Using Medication to Manage Behavior	148	(1)
8 Symptoms That Appear as Changes in Mood	149	(15)
Depression	149	(1)
Complaints about Health	150	(1)
Suicide	151	(1)
Alcohol or Drug Abuse	151	(1)
Apathy and Listlessness	152	(1)
Remembering Feelings	152	(1)
Anger and Irritability	153	(1)
Anxiety, Nervousness, and Restlessness	154	(2)
False Ideas, Suspiciousness, Paranoia, and Hallucinations	156	(7)
Misinterpretation	156	(1)
Failure to Recognize People or Things (Agnosia)	157	(1)
"You Are Not My Husband"	158	(1)
"My Mother Is Coming for Me"	158	(1)
Suspiciousness	159	(2)
Hiding Things	161	(1)
Delusions and Hallucinations	161	(2)
Having Nothing to Do	163	(1)
9 Special Arrangements If You Become III	164	(4)
In the Event of Your Death	165	(3)
10 Getting Outside Help	168	(18)
Help from Friends and Neighbors	168	(1)
Finding Information and Services	169	(2)
Kinds of Services	171	(3)
Having Someone Come into Your Home	172	(1)
Adult Day Care	172	(2)
Short-Stay Residential Care	174	(1)
Planning in Advance for Home Care or Day Care	174	(1)
When the Person with Dementia Rejects the Care	175	(2)
Your Own Feelings about Getting Respite for Yourself	177	(2)
Locating Resources	179	(2)
Paying for Care	181	(2)
Should Respite Programs Mix People Who Have Different Problems?	183	(1)
Determining the Quality of Services	184	(1)
Research and Demonstration Programs	185	(1)
11 You and the Person with Dementia as Parts of a Family	186	(19)
Changes in Roles	188	(3)
Understanding Family Conflicts	191	(3)
Division of Responsibility	192	(2)
Your Marriage	194	(1)
Coping with Role Changes and Family Conflict	194	(4)
A Family Conference	196	(2)
When You Live out of Town	198	(1)
When You Are Not the Primary Caregiver, What Can You Do to Help?	199	(1)
Caregiving and Your Job	200	(1)
Your Children	201	(4)
Teenagers	203	(2)
12 How Caring for a Person with Dementia Affects You	205	(21)
Emotional Reactions	205	(12)
Anger	206	(3)
Embarrassment	209	(1)
Helplessness	210	(1)
Guilt	210	(3)
Laughter, Love, and Joy	213	(1)
Grief	213	(2)
Depression	215	(1)
Isolation and Feeling Alone	216	(1)
Worry	216	(1)
Being Hopeful and Being Realistic	216	(1)
Mistreating the Person with Dementia	217	(1)
Physical Reactions	218	(2)
Fatigue	218	(1)
Illness	219	(1)
Sexuality	220	(2)
If Your Spouse Is Impaired	220	(2)
If Your Impaired Parent Lives with You	222	(1)
The Future	222	(3)
You as a Spouse Alone	223	(2)
When the Person You Have Cared for Dies	225	(1)
13 Caring for Yourself	226	(12)
Take Time Out	227	(3)
Give Yourself a Present	228	(1)
Friends	228	(1)
Avoid Isolation	229	(1)
Find Additional Help If You Need It	230	(4)
Recognize the Warning Signs	230	(2)
Counseling	232	(2)
Joining with Other Families: The Alzheimer's Association	234	(2)
Support Groups	234	(1)
Excuses	235	(1)
Advocacy	236	(2)
14 For Children and Teenagers	238	(4)
15 Financial and Legal Issues	242	(11)
Your Financial Assessment	242	(5)
Potential Expenses	243	(1)
Potential Resources	244	(3)
Where to Look for the Forgetful Person's Resources	247	(2)
Legal Matters	249	(4)
16 Nursing Homes and Other Living Arrangements	253	(29)
Types of Living Arrangements	254	(3)
Moving with the Person with Dementia	257	(6)
Finding a Nursing Home or Other Residential Care Setting	263	(9)
Paying for Care	265	(2)
Guidelines for Selecting a Nursing Home or Other Residential Care Facility	267	(5)
Moving to a Nursing Home or Other Residential Care Facility	272	(2)
Adjusting to a New Life	274	(4)
Visiting	274	(3)
Your Own Adjustment	277	(1)
When Problems Occur in the Nursing Home or Other Residential Care Facility	278	(2)
Sexual Issues in Nursing Homes or Other Care Facilities	280	(2)
17 Brain Disorders and the Causes of Dementia	282	(11)
Dementia	282	(7)
Dementia Associated with Alcohol Abuse	284	(1)
Alzheimer Disease	284	(2)
Vascular (Multi-Infarct) Dementia	286	(1)
Lewy Body Dementia	286	(1)
The Frontotemporal Dementias, Including Pick Disease	287	(1)
Depression	287	(1)
Binswanger Disease	288	(1)
HIV-AIDS	288	(1)
Other Brain Disorders	289	(4)
Delirium	289	(1)
Senility, Chronic Organic Brain Syndrome, Acute or Reversible Organic Brain Syndromes	290	(1)
TIA	290	(1)
Localized Brain Injuries	290	(1)
Head Injuries (Head Trauma)	291	(1)
Anoxia or Hypoxia	291	(1)
Mild Cognitive Impairment	292	(1)
18 Research in Dementia	293	(14)
Understanding Research	293	(3)
Bogus Cures	295	(1)
Research in Vascular (Multi-Infarct) Dementia and Stroke	296	(1)
Research in Alzheimer Disease	296	(4)
Structural Changes in the Brain	296	(1)
Brain Cells	296	(1)
Neurotransmitters	297	(1)
Abnormal Proteins	297	(1)
Nerve Growth Factors	298	(1)
Transplants of Brain Tissue	298	(1)
Drug Studies	299	(1)
Metals	299	(1)
Prions	299	(1)
Immunological Defects	300	(1)
Head Trauma	300	(1)
Epidemiology	300	(1)
Down Syndrome	301	(1)
Old Age	301	(1)
Heredity	301	(2)
Gender	303	(1)
Promising Clinical and Research Tools	303	(1)
Keeping Active	304	(1)
The Effect of Acute Illness on Dementia	305	(1)
Research into the Delivery of Services	305	(1)
Protective Factors	306	(1)
Appendix 1. Using the Internet	307	(2)
Appendix 2. Organizations	309	(4)
Index	313