How does caregiving unfold over time? Diseases such as Alzheimer’s disease evolve over time – usually decades. The person who is forgetful can manage early changes in memory. But as the disease progresses, there is an increasing need for external guidance, prompts, and caregiving as the problems extend beyond just forgetfulness. There are seven general stages of memory loss per the global deterioration scale. The following presents general needs for care at each stage.
Stage one – normal. This is the stage that we all hope to stay. There are the typical “senior moments.” No caregiving is needed.
Stage two – forgetfulness. In this stage there is minor consistent forgetfulness and the person in this stage is typically aware that there are changes. There may be an incident or pattern that raises minor concerns. There is no need for caregiving but this is the stage when memory assessment to obtain a baseline and proactive family planning in case of future progression is quite fruitful. Take advantage of educational programs such as those provided by the Alzheimer’s Support Network in Naples.
Stage three – early confusional state. Forgetting is noticeable by those who are close. There is slow execution of complex tasks such as doing checkbook, organization, or managing finances. Independence is still the rule but there is minor confusion. Caregiving at this stage involves support, patience, and help to put in place external memory supports such as a consistent calendar habit. Ability to do complex tasks (e.g., checkbook, finances, driving, cooking) should be assessed and monitored. Family planning in case of progression is essential but caregiving is minimal.
Stage four –late confusional stage. Forgetting is extensive. The person is befuddled. Higher order cognitive skills (e.g., balancing a checkbook, preparing a meal, finding new places, financial decision making, judgment, reasoning) often are riddled with mistakes. Caregiving may involve such things as taking over the checkbook, bill paying, helping with meal preparation, or overseeing medications. During this stage the treatment often shifts from the person with the memory loss to the caregiver as they have to increasingly take over family tasks and serve as the external memory. Husbands, wives, and children make a gradual transition to a parenteral role as there is forgetting that you forget. There may be little appreciation of what you are doing and resentment for being “treated like a child.”
Stage five – early dementia. Forgetting is very extensive, insight is lacking, and independence is no longer possible. Caregiving is demanding, stressful, and constant. The caregiver needs a plan in case they cannot provide care. What is the plan if the caregiver is out of commission for two hours, two days, two weeks, or longer? The hope is that you never need to implement the plan but you have to have the plan in place before you need it.
Stage six – middle dementia. Personal care and communication are breaking down. There are dangers such as wandering. Care at home by a single caregiver is at best difficult as the demands are usually overwhelming. The forgetful person cannot safely stay alone. 24 hour care/supervision is necessary. Either in home care or placement is necessary for safety.
Stage seven – late dementia. The disease has progressed to the point where walking, talking, and feeding oneself is no longer possible. Consider hospice services.