A person with AD may have other medical problems over time, as we all do. These problems can cause more confusion and behavior changes. The person may not be able to tell you what is wrong. You need to watch for signs of illness and tell the doctor about what you see.
The most common medical problems
Call the doctor
Call the doctor right away if the person with AD has a fever.
Having a fever means that the person’s temperature is 2 degrees above his or her normal temperature.
A fever may be a sign of:
- Infection, caused by germs
- Dehydration, caused by a lack of fluids
- Heat stroke
- Constipation (discussed later in this section)
Don’t use a glass thermometer because the person might bite down on the glass. Use a digital thermometer, which you can buy at a grocery store or drugstore.
Flu and pneumonia
These diseases spread quickly from one person to another, and people with AD are more likely to get them. Make sure that the person gets a flu shot each year and a pneumonia shot once after age 65. Most older people only need the pneumonia shot one time. The shots lower the chances that the person will get flu or pneumonia. For more information on these illnesses, visit the Centers for Disease Control and Prevention website, www.cdc.gov .
Flu and pneumonia may cause:
- Fever (Not everyone with pneumonia has a fever.)
- Aches and pains
- Breathing trouble
As AD gets worse, the person may have trouble walking and keeping his or her balance. He or she also may have changes in depth perception, which is the ability to understand distances. For example, someone with AD may try to step down when walking from a carpeted to a tile floor. This puts him or her at risk for falls.
To reduce the chance of a fall:
- Clean up clutter.
- Remove throw rugs.
- Use chairs with arms.
- Put grab bars in the bathroom.
- Use good lighting.
- Make sure the person wears sturdy shoes with good traction.
Our bodies must have a certain amount of water to work well. If a person is sick or doesn’t drink enough fluid, he or she may become dehydrated.
Signs of dehydration to look for include:
- Dry mouth
- Hallucinations (Don’t forget that hallucinations may be caused by the AD itself.)
- Rapid heart rate
Be aware of how much fluid the person is drinking. This is even more important during hot weather or in homes without air conditioning. Also, look for signs of dehydration during the winter months when heat in your home can create a lot of dry air.
People can have constipation—trouble having a bowel movement—when they:
- Change what they eat
- Take certain medicines, including Namenda®
- Get less exercise than usual
- Drink less fluid than usual
Try to get the person to drink at least 6 glasses of liquid a day.
Besides water, other good sources of liquid include:
- Juice, especially prune juice
- Gelatin, such as Jell-O®
- Melted ice cream
- Decaffeinated coffee and tea
- Liquid cereal, such as Cream of Wheat®
Have the person eat foods high in fiber. Foods like dried apricots, raisins, or prunes; some dry cereals; or soybeans might help ease constipation.
If possible, make sure that the person gets some exercise each day, such as walking. Call the doctor if you notice a change in the person's bowel habits.
Some medicines, such as Aricept®, Razadyne®, and Exelon®, may cause diarrhea—loose bowel movements. Certain medical problems also may cause diarrhea. Make sure the person takes in lots of fluids when he or she has diarrhea. Also, be sure to let the doctor know about this problem.
Incontinence means a person can't control his or her bladder and/or bowels. This may happen at any stage of AD, but it is more often a problem in the later stages. Signs of this problem are leaking urine, problems emptying the bladder, and soiled underwear and bed sheets. Be sure to let the doctor know if this happens. He or she may be able to treat the cause of the problem.
Here are some examples of things that can be treated:
- Urinary tract infection
- Enlarged prostate gland
- Too little fluid in the body (dehydration)
- Diabetes that isn't being treated
- Taking too many water pills
- Drinking too much caffeine
- Taking medicines that make it hard to hold urine
When you talk to the doctor, be ready to answer the following questions:
- What medicines is the person taking?
- Does the person leak urine when he or she laughs, coughs, or lifts something?
- Does the person urinate often?
- Can the person get to the bathroom in time?
- Is the person urinating in places other than the bathroom?
- Is the person soiling his or her clothes or bed sheets each night?
- Do these problems happen each day or once in a while?
Here are some ways you can deal with incontinence:
- Remind the person to go to the bathroom every 2 to 3 hours.
- Show him or her the way to the bathroom, or take him or her.
- Make sure that the person wears loose, comfortable clothing that is easy to remove.
- Limit fluids after 6 p.m. if problems happen at night. Do not give the person fluids with caffeine, such as coffee or tea.
- Give the person fresh fruit before bedtime instead of fluids if he or she is thirsty.
- Mark the bathroom door with a big sign that reads "Toilet" or "Bathroom."
- Use a stable toilet seat that is at a good height. Using a colorful toilet seat may help the person identify the toilet. You can buy raised toilet seats at medical supply stores.
- Help the person when he or she needs to use a public bathroom. This may mean going into the stall with the person or using a family or private bathroom.
Things you may want to buy:
- Use adult disposable briefs or underwear, bed protectors, and waterproof mattress covers. You can buy these items at drugstores and medical supply stores.
- Use a drainable pouch for the person who can't control his or her bowel movements. Talk to the nurse about how to use this product.
Some people find it helpful to keep a record of how much food and fluid the person takes in and how often he or she goes to the bathroom. You can use this information to make a schedule of when he or she needs to go to the bathroom.
As AD gets worse, people need help taking care of their teeth or dentures.
Check the person's mouth for any problems such as:
- Decayed teeth
- Food "pocketed" in the cheek or on the roof of the mouth
Be sure to take the person for dental checkups. Some people need medicine to calm them before they can see the dentist.
Other medical problems
Always remember that the person with AD may not be able to tell you when he or she is in pain. Watch the person's face to see if it looks like he or she is in pain or feeling ill. Also, notice sudden changes in behavior such as increased yelling or striking out. If you are unsure what to do, call the doctor for help.
People with AD can have the same medical problems as many older adults. Research suggests that some of these medical problems may be related to AD.
For example, some heart and blood circulation problems, stroke, and diabetes are more common in people who have AD than in the general population. Diseases caused by infections also are common.
Be sure to take the person to the doctor for regular checkups.
Visiting the doctor
It's important that the person with AD get regular medical care.
Here are some tips to help you get ready for a visit to the doctor's office:
- Make an appointment during the person's best time of day and when the office is not very crowded.
- Let the office staff know before the visit about the person's AD. Ask them for help to make the visit go smoothly.
- Don't tell the person with AD about the visit until the day of the visit or even right before it is time to go if visiting the doctor makes the person nervous. Be positive and matter of fact.
- Take something he or she likes to eat or drink and any materials or activities the person enjoys.
- Have a friend or family member go with you, so that one of you can stay with the person while the other speaks with the doctor.
- Take a brief summary listing the person's medical history, primary care doctor, and current medications.
Going to the emergency room
A trip to the emergency room (ER) can be very stressful for both the person with AD and you.
Here are some ways to cope with ER visits:
- Take a list of medicines, insurance cards, the health care provider's name and phone number, and advance directives. Advance directives are signed documents, such as a living will, that spell out a patient's wishes for end-of-life care.
- Ask a friend or family member to go with you or meet you in the ER. He or she can stay with the person while you answer questions.
- Be ready to explain the symptoms and events leading up to the ER visit. You may have to repeat this more than once to different staff members.
- Tell ER staff that the person has AD. Explain how best to talk with the person.
- If the person with AD must stay overnight in the hospital, try to have a friend or family member stay with him or her.