The breakdown of our mother’s body did not occur suddenly just as the disruption of her mental processes had not.  Interdisciplinary studies remind us that the body is an open system, with many parts working together.  If one part is ailing, in time other parts will be affected.  As the old spiritual claims, “the ankle bone is connected to the shin bone,” and so on.

Clearly Alzheimer’s is a disease of the brain with apparent deterioration of mental functions.  But in time the misfiring or blocked neurological signals impact negatively other body systems.  Whether this relationship is labeled psycho physiological is a mute point. Our mother’s symptoms were not just “in her head.”

We can’t sort out what was a part of the aging process and what can be attributed to Alzheimer’s.  But the deterioration was inclusive.

In our book my sister and I chronicle the development of physical challenges, with their incremental changes across the years and suggested caregiver responses.*  The categories of our greatest caregiving concerns and  of our mother’s deepest distress were: inability to chew/swallow food or medicine; incontinence; loss of motor skills, especially the ability to stand or walk; insomnia; refusal to bathe and resistance to changing clothing; loss of language skills; and finally extremely erratic vital signs, including respiration, blood pressure and heart rate. 

The magnitude of these afflictions can’t be summarized or help adequately given on a web site.  But I will address some of the lessons we learned as physical problems developed.

At mealtime Mother joined us at the table at first, but gradually she took no initiative to eat.  Sometimes simply handing her a fork or spoon got her started and she could complete her meal.  In time, her comprehension of the process failed.  We fed her.  As the problem worsened we pureed her food (using a hand-held blender), carried it to her lift chair or the bed and fed her.  A meal could sometimes take hours as we approached and re-approached when she denied food.  I recall with such appreciation the things my sister did to present mother’s foods attractively – a touch of color, a flower, cloth placemats and napkins, and always one or more of her favorite foods.** 

If artificial feeding methods are ever considered, they should be carefully analyzed by a qualified physician and supported by the loved one’s will, written or understood. 

Incontinence is physically and emotionally taxing for everyone.  The emotional impact of a loved one losing control of body functions accentuates feelings already raging about regression, dependence, and role reversal. 

At first we were fortunate when Mother gave cues about bathroom needs.  She would start folding her lap cover or glance furtively around the room.  We knew to get in gear!  As incontinence develops, do not hesitate to use disposable under garments.  A friend once said to me about his demented mother, “I handled her illness OK until we had to use diapers.” Apparently this phase punctuated the ultimate humiliation he felt his mother could suffer from intrusive procedures.  As painful as this transition is, we knew it enabled us to keep Mother clean and dry. 

When it is necessary to confine a loved one to bed, enlisting a home health aid to teach the skills needed to change clothing and bed linens and bathe him/her is a life saver. 

Throughout the Alzheimer’s journey, keep your loved one in touch with medical resources.  Doing so can assure that medications are given to help properly maintain vital functions such as blood pressure, temperature, glucose levels, and changes in emotional and mental activity. 

In the areas of grooming and bathing, we experienced an evolution in dependence as we did in all areas of Mother’s life.  At first, she chose clothing that violated her “show of flesh norm.”  Then, she often refused to bathe.  As she became more confused, we took bathroom safety precautions, including grab bars, non skid rugs, etc.  We reminded, assisted, left notes, coaxed, guided, and helped her with actions she forgot or could not do.  We recognized the importance of her doing what she could do, such as brushing her teeth and washing private body parts.  Eventually, we orchestrated the entire experience but gave her a cloth to hold and use when she could. 

We knew mother well enough to recognize certain amenities would help:  a warm room, letting her test the water before stepping into the tub, an extra towel for privacy, soft lights, words of reassurance, and a delightful aroma.  In time, her bath was a sponging off in bed topped with a gentle massage on and around bony prominences to aid circulation, and a slathering with skin protectant creams and lotions. 

Recognize the tension between wanting to keep the loved one active as long as possible and the limitations of his/her body.  We were still trying to coax our Mother to walk to the bathroom, or to get out of bed into her recliner chair, when she simply had lost the strength to do so. She would collapse onto the floor. 

Finally, we understood that these efforts were for us, not for her.  We would let her rest her frail, courageous body.

*Please Take Me Home Before Dark, Billie Pate and Mary Yarnell

**Read also “ When Mealtime Becomes Challenging,” on this web site