Thursday, April 22, 2010

The 36-Hour Day by Nancy L. Mace and Peter V. Rabins

Subtitled “A Family Guide for Caring for People with Alzheimer Disease, Other Dementias, and Memory Loss in Later Life,” this fourth edition of The 36-Hour Day focuses on the nitty-gritty details of home care of dementia patients.

The three chapters with “Problems” in the title can help the caregiver to anticipate and recognize issues that may come up. For example, the confused person may not be able to tell you about pain, even if he can still speak clearly. You need to monitor their behavior.

Demented people aren’t responsible for their own behavior. Often they’ve forgotten safety rules, so they may taste or drink things they find in their environment, including mouthwash, or shampoo, as well as more dangerous substances. Since most people expect adults to look both ways while crossing the street, or move quickly, they may not be prepared to stop for a person with dementia in a parking lot or crossing the street.

Behavioral and mood changes often manifest in dementias. Most folks have experienced their loved one repeating questions, even ones that were asked and answered a few minutes earlier. People who were always even-tempered may suddenly become irritable, angry, aggressive, or stubborn. They may follow you around constantly. The authors explain why these behaviors may develop and provide specific ways to manage.

Caregivers may find the “Six R’s of Behavior Management” helpful to remember: Restrict, Reassess, Reconsider, Rechannel, Reassure, and Review.


The authors encourage caregivers to check with their local Alzheimer’s Association Chapter; this group provides support, information, and publishes helpful newsletters. Search by your zip code from the national site.

Even though The 36-Hour Day is about problems of home care, it is very useful for everyone who is involved in any way with care of a loved-one who has a dementia. It helps you know what to expect and provides some advice on appropriate care and intercession. For example, if you notice red areas on elbows, then you need to report this to the nursing staff where the loved-one lives. This may be an indication of a pressure sore that needs to be watched and cared for. Pressure sores can occur even on a person who is not bedbound if she spends a lot of time leaning on that elbow.

When home care goes wrong—or at least becomes absurd—is the tragicomedy Welcome to the Departure Lounge : Adventures in Mothering Mother by Meg Federico. In this memoir, Meg is a long distance caregiver responsible for her mother. Her stepsister is responsible for her stepfather, who is abusive, alcoholic, and has Alzheimer’s. The parents are irascible, sneaky, uncooperative and, of course, unable to help it. Meg and her stepsister constantly have to step in to referee the two sets of hired caregivers/housekeepers. Anyone who is caring for a family member at home or at a distance will recognize many of the situations Meg describes.

1 comment:

Diane W said...

I read the 36 Hour Day and found it very informative and helpful - even for those who don't currently have someone in their life with dementia. This has been a very interesting week of reviews - thanks.