How do you work with a client that has Alzheimer’s disease? She is 76 years old and is so anxious that all she does with me is walk and ride bikes.

Makeadifference: That is a bit of a paradox. Please ensure that she doesn't sustain injury to her person while riding a bike.

Make sure she doesn't have sleep apnea. My mom has adrenaline on board during the day to compensate for the lack of sleep. Once she got on a CPAP the hyperactivity stopped.

UNCLEAR: A woman with dementia / Alz is riding a bike? WHY? Who is allowing this? Not okay. Someone needs to be responsible for this person's well being. And protect her from herself.

* Work with family.
* Educate yourself with dementia / behaviors through Teepa Snow's website. She is one of the country's leading experts on dementia and offers free email information and webinars. I studied with her on-line webinars for two years.
* Work with social worker or any social service provider she gets that could coordinate care with you, with family.
* She may need to have meds (adjusted). This is something family could pursue IF there is a POA in place.
* If this person is a client (or even if you are a family member), and she is considered to be mentally competent, there is little you can do - without going in circles - to no avail. Never ever argue with a person with dementia. As you say she has Alz., she may need placement in a facility - as often this is too much for family or a caregiver (there on limited schedule) to manage.
* Take to medical provider, family, social worker(s) - insure that legal documentation is in place to make decisions this person cannot make on their own. If she is diagnosed with Alz., she is not competent to make legal decisions on her own behalf. Someone else needs to do - family, state.

Gena Galenski
Touch Matters

It is not clear from your note if you are a family member or friend or a paid caregiver ?? Her doctor needs to be consulted regarding activities by the family member listed as POA or PCG . For purely safety and liability reasons everyone needs to be following the professionals POC ,....this may include a referral to an dementia specialist or local Alz./Dementia group who can provide a wealth of information. You can also access the Alz. Association on line ....,
Since you say that you are " with her 3 days a week" it begs the question if you are a paid caregiver ? or another loving family member? IF you are a paid caregiver, you should be communicating these needs to your employer so that they can assess needs and appropriate follow up.
For your own protection and the primary safety of the patient, consult with the professionals caring for her and, your agency if you are indeed a paid caregiver working through an agency.

Wish they could clone you!

How about starting with a Geriatric Psychiatrist to help mom calm down and orchestrate her happy place: if she could do anything about changing up her life, what would she do? Where would she go? Who would she visit and request the pleasure of their visit? Would she like to adopt a pet? Hobbies? Talents? Online games. Has she ever tried the LUMOSITY site?

Can you or other family members take her on excursions to the senior events coming up around the holidays? Does she like BINGO? Is she interested in doing volunteer work? Does she paint, knit or crochet?

What music makes her happy?

Does she know how lucky she is to have YOU?

Aermay has already mentioned mall walking - I know that going to the mall doesn't have the cachet it used to but for those of us with winter weather it is still a very popular place for seniors to get their exercise (and maybe meet up with others for a coffee at the food court).

Why do you assume ALZ?
She may have been active all her life and cannot accept the
limitations of old age. Even 2020 limited us severely as far as
"outlets".

Remember activity wards off muscle atrophy / arthritis and the dulling of the mind. Accept what she is and make sure she uses common sense.

The personality under the dementia will stay. You are right to be concerned because as dementia progresses she will underdress and may eventually get lost. Unfortunately for her, if she gets into MC she will be locked in.

Since you are concerned, it might help if you contact her on those bad weather days.

Can your client get interested in any different activity with no commitments? However, must register to get started.

For example, I attend a free senior low-inpact in class free video activities, and the exercises are repetitive instructions for one hour 3 days weekly. I can miss a class but return at my convenience if busy. Just love it and the participants! Because I have autism, this program in Daly City, CA is perfect for me.

Maybe she would try a senior center if you changed the approach. If you are going to help others, to “volunteer” she may be willing to go. I’ve done this with a client, and of course I was there with my client. I spoke to the senior center staff first and there were small things she could do….help serve lunch, hand out or clean up activity materials, be assigned to chat with a lonely senior….if she feels needed and isn’t seeing herself as “old” she may be willing to do it.

A couple comments.
Walking in the winter can be safe.
Good boots if there is snow.
Proper dress for the cold and wind. This might be a time that Cross Country Skiing might be a new hobby.
The point is properly dressed a walk in the winter is possible. So if she get agitated and "needs" to walk outdoors please consider it.
Getting to the agitation. There are medications that can help BUT the medication may make her a bit unsteady so watch for any side effects and adjust daily activities as needed.
Mall Walking is a possibility if there is a nice safe mall near by. (sad thing around me is many Malls have closed or remodeled and are now "outdoor" malls with no inside area to walk.)
Check the local Park District many have indoor areas with walking tracks.
The local Y might also be an option and you would have to option for other activities as well. (some insurance plans cover the Y and a few other fitness places)
The place I took my Husband for Day Care had a woman that walked the hall non stop all day. Maybe she stopped for lunch but I never saw that. I just had to be careful that when I brought my Husband there or picked him up she was headed away from the door so that she could not "escape" when entered the code and opened the door.

Is there a mall nearby where you could walk when the weather turns? Maybe have her family get a treadmill or stationary bike? She is lucky to have you.

They used to have exercise tapes, where the 2 of you (along with a doctor's OK), can do these exercises, often set to music. Also, some community groups and houses of worship sometimes have exercise classes for seniors that are open to the community. I took my mom to one, when she had Alzheimer's, and it was wonderful for the both of us: the exercise and sociability. Senior centers often offer similar types of programs. During Covid, some of these were virtual. Now, depending upon the facility, I think some are in person and perhaps some are hybrid.

During the winter months you could take her mall-walking if you have a shopping mall in the area.
I see senior walking clubs at the mall near me all the time. A lot of them go with their home/health aides because they need supervision. From what I've seen these people have a good time. They walk the whole place then stop off at the food court for refreshments and to sit for a while.
Call the senior center in your area and talk to them. They might have a mall-walkers club that you can bring your client to.

For many of us, exercise is the most effective way to reduce stress and anxiety. When the weather keeps me inside, I put on marching band music and March around the house with big arm movements (think drum major). The music lifts my spirits and gets me motivated. Alternatively, I put on favorite dance music and dance. I’m a terrible dancer, so I consider it comedy. All of this is good therapy for me.

With my grandson ADD/ADHD is mainly being able to focus. He does very well doing Warehouse work but had a problem in shipping with packaging the orders where there was a set pattern. He also has trouble with looking ahead. Not sure how someone with ALZ would be since these are also signs of the desease.

IMO, you are not going to be able to teach her anything new. Her short-term memory does not allow it.

"colouring in, easy jigsaw puzzles." I have a couple of the wood puzzles that Fisher Price made from 45 yrs ago. A friend was suggested this kind of Puzzle for her husband suffering from ALZ. I loaned her mine. Coloring should probably be the same way. Maybe a coloring book for grade school ages. Personnally, I so hope if I have Dementia, that they don't have me color. Haven't liked to do it since 2nd or 3rd grade when it was "color all the even #s blue and all the odd #s red".😁

I like idea of walking a Mall. Can window shop, eat lunch, have a snack. Maybe an aerobics class.

How wonderful that she still wants to remain so active! That is a blessing for sure, as so many dementia patients just want to sit around and do much of nothing other than perhaps just watch TV.
You can take her to an indoor mall to walk in the winter months or when the weather doesn't cooperate to be outdoors. She could also go to an Adult Day Care center up to 5 days a week, as they keep the folks there pretty active and as busy as they want to be.
The YMCA could also be a good choice as they offer "Silver Sneaker" classes along with other classes appropriate for the elderly.
Keeping her active will certainly benefit her(and you)in the long run, so just keep her moving best you can.

Firstly I'd like to mention this is not denial. The brain gets damaged & yet does not know it is damaged. What looks like denial is *lack of insight*. Medical name Anosognosia. Have a look at the care topics for this if you want to research this.

I would recommend Teepa Snow's approach for care. Plenty of info via Google search & many really interesting videos & talks.

Thr 'emerald' stage in particular describes people who are on the go. Can be on the go go go physically or in a repetitive verbal loop unable to stop. There is a really good video showing how to distract & realign the person to another activity or take a much needed rest. The lack of insight prevents them from recognising when they need to stop or slow down themself, or even other essential self-care requirements eg eat & drink.

ADD (or ADHD) may add another layer of behaviour that is tricky to manage, but not impossible.

Maybe once the lady seems physically tired of walking/riding/using her big muscles - an activity could be introduced to use smaller muscles eg fidget spinners, colouring in, easy jigsaw puzzles.

Is there a Physio or OT on her care team? I think an OT could really help with activities. The Doctor may be able to prescribe medication to lesson the agitation (if appropriate) too.

While some may say, well let her walk all day if she wants.. and I get that.. as a support worker you have some duty of care to protect her from known risks eg over exercion in hot weather & dehydration.

Our indoor malls are full of walkers during the summer. Climate controlled, security and coffee after.

It would be reversed if we had nice summers and brutal winters.

Studies have shown learning (or trying to learn) something new can help stave off the effects of dementia. Perhaps finding an interest for her and working on that part of the time can help her be less anxious. You know, like learning a new language, anything to help her focus.

A yoga class. Inside, exercise, and calming.

If she's "so anxious", perhaps she could benefit from a small amount of something to calm her anxiety a bit? I would not want my mom to be that anxious all the time. Doesn't sound like a good place to be, IMHO.

Get her to check out the senior center with you. She'll quickly see it's not all wheelchairs.

How about cleaning her apartment? Can walk malls or even Target or the grocery store.

Join a gym? Planet Fitness, where I was a member for years, has cheap memberships and she could get the one where she can bring a guest (you!).

Good luck.