The 36-hour Day

by Mace, Nancy L.

• ISBN13: 9780801885105
• ISBN10: 0801885108
• Edition: 4th
• Format: Paperback
• Copyright: 2006-10-17
• 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	xix
Preface	xxiii
Acknowledgments	xxvii
1 Dementia	1	(19)
What Is Dementia?	9	(3)
The Person with Dementia	12	(5)
Where Do You Go from Here?	17	(3)
2 Getting Medical Help for the Person with Dementia	20	(16)
The Evaluation of the Person with a Suspected Dementia	21	(7)
Finding Someone to Do an Evaluation	28	(2)
The Medical Treatment and Management of Dementia	30	(6)
The Physician	30	(1)
The Nurse	31	(2)
The Social Worker	33	(1)
The Geriatric Care Manager	34	(1)
The Pharmacist	34	(2)
3 Characteristic Behavioral Symptoms of Dementia	36	(42)
The Brain, Behavior, and Personality: Why People with Dementia Do the Things They Do	37	(6)
Caregiving: Some General Suggestions	43	(4)
Memory Problems	47	(1)
Overreacting, or Catastrophic Reactions	48	(9)
Combativeness	57	(1)
Problems with Speech and Communication	58	(11)
Problems the Person with Dementia Has in Making Himself Understood	59	(5)
Problems the Person with Dementia Has in Understanding Others	64	(5)
Loss of Coordination	69	(5)
Loss of Sense of Time	74	(2)
Symptoms That Are Better Sometimes and Worse at Other Times	76	(2)
4 Problems in Independent Living	78	(26)
Mild Cognitive Impairment	78	(4)
When a Person Must Give Up a Job	82	(2)
When a Person Can No Longer Manage Money	84	(2)
When a Person Can No Longer Drive Safely	86	(6)
When a Person Can No Longer Live Alone	92	(12)
When You Suspect That Someone Living Alone Is Getting Confused	93	(4)
What You Can Do	97	(1)
Moving to a New Residence	98	(6)
5 Problems Arising in Daily Care	104	(68)
Hazards to Watch For	104	(11)
In the House	107	(4)
Outdoors	111	(2)
In the Car	113	(1)
Highways and Parking Lots	113	(1)
Smoking	114	(1)
Hunting	114	(1)
Nutrition and Mealtimes	115	(15)
Meal Preparation	116	(1)
Mealtimes	117	(3)
Problem Eating Behaviors	120	(3)
Malnutrition	123	(1)
Weight Loss	124	(1)
Choking	125	(2)
When to Consider Tube Feeding	127	(3)
Exercise	130	(3)
Recreation	133	(5)
Meaningful Activity	137	(1)
Personal Hygiene	138	(12)
Bathing	140	(4)
Locating Care Supplies	144	(1)
Dressing	145	(2)
Grooming	147	(1)
Oral Hygiene	148	(2)
Incontinence (Wetting or Soiling)	150	(10)
Urinary Incontinence	151	(5)
Bowel Incontinence	156	(1)
Cleaning Up	157	(3)
Problems with Walking and Balance; Falling	160	(6)
Becoming Chairbound or Bedbound	163	(2)
Wheelchairs	165	(1)
Changes You Can Make at Home	166	(6)
Should Environments Be Cluttered or Bare?	169	(3)
6 Medical Problems	172	(37)
Pain	175	(1)
Falls and Injuries	176	(1)
Pressure Sores	177	(1)
Dehydration	178	(1)
Pneumonia	178	(1)
Constipation	179	(2)
Medications	181	(5)
Dental Problems	186	(1)
Vision Problems	187	(3)
Hearing Problems	190	(1)
Dizziness	191	(1)
Visiting the Doctor	191	(2)
If the Ill Person Must Enter the Hospital	193	(3)
Seizures, Fits, or Convulsions	196	(2)
Jerking Movements (Myoclonus)	198	(1)
The Death of the Person with Dementia	199	(10)
The Cause of Death	199	(1)
Dying at Home	200	(1)
Hospice	201	(1)
Dying in the Hospital or Nursing Home	202	(1)
When Should Treatment End?	202	(2)
What Kind of Care Can Be Given at the End of Life?	204	(5)
7 Behavioral Symptoms of Dementia	209	(52)
The Six R's of Behavior Management	210	(2)
Concealing Memory Loss	212	(3)
Wandering	215	(14)
Reasons That People Wander	215	(3)
The Management of Wandering	218	(11)
Sleep Disturbances and Night Wandering	229	(5)
Worsening in the Evening ("Sundowning")	234	(2)
Losing, Hoarding, or Hiding Things	236	(2)
Rummaging in Drawers and Closets	238	(1)
Inappropriate Sexual Behavior	238	(4)
Repeating the Question	242	(1)
Repetitious Actions	243	(1)
Distractibility	244	(1)
Clinging or Persistently Following You Around	245	(2)
Complaints and Insults	247	(5)
Taking Things	252	(1)
Forgetting Telephone Calls	253	(1)
Demands	254	(3)
Stubbornness and Uncooperativeness	257	(1)
When the Person with Dementia Insults the Sitter	258	(2)
Using Medication to Manage Behavior	260	(1)
8 Symptoms That Appear as Changes in Mood	261	(27)
Depression	261	(2)
Complaints about Health	263	(1)
Suicide	264	(1)
Alcohol or Drug Abuse	264	(2)
Apathy and Listlessness	266	(1)
Remembering Feelings	267	(1)
Anger and Irritability	268	(2)
Anxiety, Nervousness, and Restlessness	270	(3)
False Ideas, Suspiciousness, Paranoia, and Hallucinations	273	(13)
Misinterpretation	274	(2)
Failure to Recognize People or Things (Agnosia)	276	(1)
"You Are Not My Husband"	277	(1)
"My Mother Is Coming for Me"	277	(1)
Suspiciousness	278	(5)
Hiding Things	283	(1)
Delusions and Hallucinations	283	(3)
Having Nothing to Do	286	(2)
9 Special Arrangements If You Become Ill	288	(6)
In the Event of Your Death	291	(3)
10 Getting Outside Help	294	(32)
Help from Friends and Neighbors	295	(4)
Finding Information and Services	299	(1)
Kinds of Services	299	(7)
Having Someone Come into Your Home	301	(1)
Adult Day Care	302	(2)
Short-Stay Residential Care	304	(2)
Planning in Advance for Home Care or Day Care	306	(1)
When the Person with Dementia Rejects the Care	306	(5)
Your Own Feelings about Getting Respite for Yourself	311	(2)
Locating Resources	313	(4)
Paying for Care	317	(4)
Should Respite Programs Mix People Who Have Different Problems?	321	(1)
Determining the Quality of Services	322	(2)
Research and Demonstration Programs	324	(2)
11 You and the Person with Dementia as Parts of a Family	326	(34)
Changes in Roles	329	(7)
Understanding Family Conflicts	336	(4)
Division of Responsibility	337	(3)
Your Marriage	340	(1)
Coping with Role Changes and Family Conflict	341	(7)
A Family Conference	343	(5)
When You Live out of Town	348	(1)
When You Are Not the Primary Caregiver, What Can You Do to Help?	349	(3)
Caregiving and Your Job	352	(1)
Your Children	353	(7)
Teenagers	357	(3)
12 How Caring for a Person with Dementia Affects You	360	(36)
Emotional Reactions	360	(21)
Anger	362	(5)
Embarrassment	367	(2)
Helplessness	369	(1)
Guilt	370	(4)
Laughter, Love, and Joy	374	(1)
Grief	375	(2)
Depression	377	(2)
Isolation and Feeling Alone	379	(1)
Worry	379	(1)
Being Hopeful and Being Realistic	380	(1)
Mistreating the Person with Dementia	381	(2)
Physical Reactions	383	(2)
Fatigue	383	(1)
Illness	384	(1)
Sexuality	385	(5)
If Your Spouse Is Impaired	386	(3)
If Your Impaired Parent Lives with You	389	(1)
The Future	390	(5)
You as a Spouse Alone	392	(3)
When the Person You Have Cared for Dies	395	(1)
13 Caring for Yourself	396	(21)
Take Time Out	398	(4)
Give Yourself a Present	400	(1)
Friends	400	(1)
Avoid Isolation	401	(1)
Find Additional Help If You Need It	402	(8)
Recognize the Warning Signs	403	(3)
Counseling	406	(4)
Joining with Other Families: The Alzheimer's Association	410	(4)
Support Groups	411	(2)
Excuses	413	(1)
Advocacy	414	(3)
14 For Children and Teenagers	417	(6)
15 Financial and Legal Issues	423	(19)
Your Financial Assessment	423	(9)
Potential Expenses	424	(2)
Potential Resources	426	(6)
Where to Look for the Forgetful Person's Resources	432	(4)
Legal Matters	436	(6)
16 Nursing Homes and Other Living Arrangements	442	(50)
Types of Living Arrangements	446	(3)
Moving with the Person with Dementia	449	(11)
Finding a Nursing Home or Other Residential Care Setting	460	(17)
Paying for Care	463	(4)
Guidelines for Selecting a Nursing Home or Other Residential Care Facility	467	(10)
Moving to a Nursing Home or Other Residential Care Facility	477	(2)
Adjusting to a New Life	479	(8)
Visiting	480	(4)
Your Own Adjustment	484	(3)
When Problems Occur in the Nursing Home or Other Residential Care Facility	487	(3)
Sexual Issues in Nursing Homes or Other Care Facilities	490	(2)
17 Brain Disorders and the Causes of Dementia	492	(18)
Dementia	492	(12)
Dementia Associated with Alcohol Abuse	495	(1)
Alzheimer Disease	496	(2)
Vascular (Multi-Infarct) Dementia	498	(1)
Lewy Body Dementia	499	(1)
The Frontotemporal Dementias, Including Pick Disease	500	(1)
Depression	501	(1)
Binswanger Disease	502	(1)
HIV-AIDS	502	(2)
Other Brain Disorders	504	(5)
Delirium	504	(2)
Senility, Chronic Organic Brain Syndrome, Acute or Reversible Organic Brain Syndromes	506	(1)
TIA	506	(1)
Localized Brain Injuries	507	(1)
Head Injuries (Head Trauma)	507	(1)
Anoxia or Hypoxia	508	(1)
Mild Cognitive Impairment	509	(1)
18 Research in Dementia	510	(25)
Understanding Research	511	(4)
Bogus Cures	514	(1)
Research in Vascular (Multi-Infarct) Dementia and Stroke	515	(1)
Research in Alzheimer Disease	516	(7)
Structural Changes in the Brain	516	(1)
Brain Cells	516	(1)
Neurotransmitters	516	(1)
Abnormal Proteins	517	(2)
Nerve Growth Factors	519	(1)
Transplants of Brain Tissue	519	(1)
Drug Studies	520	(1)
Metals	521	(1)
Prions	521	(1)
Immunological Defects	522	(1)
Head Trauma	522	(1)
Epidemiology	523	(1)
Down Syndrome	524	(1)
Old Age	524	(1)
Heredity	525	(3)
Gender	528	(1)
Promising Clinical and Research Tools	528	(2)
Keeping Active	530	(1)
The Effect of Acute Illness on Dementia	531	(1)
Research into the Delivery of Services	531	(1)
Protective Factors	532	(3)
Appendix 1. Using the Internet	535	(2)
Appendix 2. Organizations	537	(6)
Index	543