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Practical Care-giving For An Alzheimer’s Patient: Caring For A Person With Alzheimer’s Can Be Difficult And Intense

There are many practical implications to caring an Alzheimer’s patient. Here is a basic guide to what may be encountered.


The ability to drive is normally decided on a case by case basis. If there is any chance of the person getting lost or endangering lives, then driving should not be allowed.


Many patients hold on to this area of control. So long as they are dressed appropriately for the weather and don’t have their underwear on top of outer garments, it is best to allow them to retain this freedom as long as possible.

Grooming Issues

A patient may reach the stage where he cannot attend to any personal grooming. In this case:

  • Keep the patient’s hair in a short, easy style to manage
  • Allow male patients to grow a beard to do away with the daily shaving ritual
  • Keep nails trimmed and check for ingrown toenails
  • Dress the patient in loose, easy to fasten clothing

Personal Hygiene

Patients in advanced stages of the disease will generally require assistance to bathe. Here are some points to be aware of:

  • Fear of running water or water falling on the head is common
  • Shower or bath chairs can make the process easier
  • Use non-slip mats in baths and showers
  • Sponge baths can suffice on alternate day so long as the genital area is kept clean
  • Modesty can be an issue. Allow the person to wear a robe in the shower for this reason.

Oral Hygiene

Alzheimer’s patients will reach the stage where they need assistance with brushing their teeth. Check for raw patches and ill fitting dentures as part of daily care. Swabs impregnated with toothpaste are available if the patient will not open his mouth properly. (Be careful of being bitten).

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This occurs for two main reasons:

  • Age related conditions such as weakened pelvic muscles
  • Confusion when trying to find a bathroom and inability to get clothes off quickly

Try not to make a fuss if an accident happens. Rather schedule regular bathroom visits and look for signs that the patient needs the toilet. There is an excellent range of adult pads and diapers available if incontinence becomes a big problem.


If the patient is bedridden, turn him every three hours to prevent bedsores from forming. A sheepskin can help cushion tender flesh.

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Keep meals to a regular schedule and make sure the patient is eating enough. Swallowing becomes difficult for some in the latter stages of the disease.

  • Serve food cut into small pieces
  • Offer finger foods
  • Serve the patient in a room where he is comfortable
  • Keep distractions to a minimum


Light exercise is to be encouraged. Look at things like walking, dancing and gardening. If the patient enjoyed swimming in the past, the caregiver could swim with him, ensuring he is wearing a life jacket.

Sleeping Arrangements

Sleep problems are common and are the main reason for placing patients in residential care. To settle a patient at bedtime, try these tips:

  • Restrict caffeine to six hours before bedtime
  • Don’t allow heavy snacks close to bedtime
  • Have a bedtime routine

Keeping Track of a Loved One

In case a patient goes wandering, mark all his clothing with iron on labels giving his name, address and phone number. Mark underwear and socks as well. A medic alert or safe return bracelet are also options.

An Alzheimer’s patient generally has more than one caregiver. If they all follow the same routines and rules, life will be more settled and easier for all concerned.

Testing For H1N1 Suspended In Many Areas: Is Tamiflu Resistance Being Underreported?

Strain-specific testing for 2009 H1N1 influenza (swine flu) has been suspended in many areas due to the high prevalence of this pandemic strain in the human population.

Public health officials report that widespread confirmatory testing is superfluous and not cost-effective: Testing can be omitted, they say, in the majority of patients who present with flu-like symptoms because 2009 H1N1 is now the most common bug around.

Unfortunately, influenza is a very adaptable virus—some would call it “sloppy,” due to the promiscuous and random nature of its genetic acquisitions. It freely shares information with other viruses that cohabit the same infected cell; its genome shifts, drifts, and recombines faster than virologists can keep up with it.

It is influenza’s propensity for rapid genetic transformation that makes vaccine development so difficult: An immunization that appeared to be a good viral match in midsummer is suddenly rendered ineffectual as new strains emerge in the fall.

Virology Basics: The Structure of Influenza A (H1N1)

Influenza A viruses all share a common structure:
  1. A viral envelope, composed of lipoproteins and glycoproteins (including the variable “H” and “N” antigens)
  2. A viral genome, consisting of eight single, highly-segmented RNA strands that contain the codes for eleven proteins needed for construction and function of a mature virus
Structure and Function Elegantly Combine
  • The manufacture of all viral proteins takes place in the hijacked nucleus of an infected cell
  • The segmented nature of influenza’s RNA allows for free exchange of entire genes between different viruses, as well as the frequent breaking and random recombining of genetic segments
  • Polymorphisms (“many forms”) exist within the population of influenza viruses; these may be due to differences in entire gene segments or to point mutations within a single gene
  • Most polymorphisms are the result of random mutation and confer no evolutionary benefit to the virus, but some allow the virus to survive and replicate more efficiently in certain environments (higher temperatures, different species, etc.)
  • Specific polymorphisms may derive survival benefits under certain environmental pressures (the development of bacterial resistance to antibiotics is a classic example of one polymorphism conferring an advantage over another due to a selective force that eliminates only the susceptible bacteria)

Emerging Tamiflu (Oseltamivir) Resistance in Novel H1N1

As of March 2009, analyses of viruses circulating in the United States revealed that 98% of the “garden-variety” flu (a different H1N1 strain) was resistant to Tamiflu, a drug commonly used to treat influenza. Scientists were puzzled by the near-universal resistance of influenza to Tamiflu, and public health experts who had stockpiled the drug in preparation for a pandemic of highly-lethal H5N1 (avian flu) were understandably concerned.

Further investigation revealed that the development of Tamiflu resistance was probably not due to the overuse of the drug, but arose instead as the result of a spontaneous mutation in the viral genome. More ominous, however, was the finding that the new mutation not only conferred resistance to oseltamivir; it seemed to increase the virus’ ability to infect people. (Dharan N, et al. Infections with oseltamivir-resistant influenza A (H1N1) virus in the United States. JAMA. 2009;301[10]:1034-41)

Enter 2009 H1N1…

On June 30, 2009, a case of Tamiflu-resistant influenza A/H1N1 (pandemic “swine flu”) was reported in Denmark.

On August 15 the World Health Organization reported Tamiflu-resistant cases in patients from Hunan, China and Singapore (where H5N1 remains endemic).

On August 22 the Centers for Disease Control and Prevention reported that six cases of Tamiflu-resistant 2009 influenza A/H1N1 had been detected in the United States.

Unfortunately, only about 1,000 samples had been tested for Tamiflu resistance in the U.S. Nearly 9,000 people with swine flu had already been hospitalized here by that time, and an untold number of infected individuals remained at home, effectively excluded from the database.

Henry Niman, PhD, of Recombinomics, Inc., reports an increasing detection rate for the H274Y polymorphism that confers Tamiflu resistance in 2009 pandemic flu. He agrees that this polymorphism—apparently the result of a random mutation—has been present in the viral genome for some time, and he summarizes reports of resistant cases in Seattle, California, Texas, and North Carolina.

In other words, all across America, drug-resistant strains of pandemic H1N1 influenza are emerging; due to limited surveillance, public health officials probably aren’t cognizant of the full breadth of the problem and there may be more surprises from this ever-changing organism that are flying just beneath the radar.