Helping People with Progressive Memory Disorders »

Chapter 5: Ways to Help Memory Problems

Memory problems (amnestic disorders) vary. Some people have occasional or mild memory problems. Others have a severe progressive memory decline. When applying memory strategies, it is important to fit the strategy to the specific problem and to remember that people vary. Some memory strategies work well for some people and not at all for others. Sometimes what works today may not work tomorrow but works again next week. It may take a few tries to find the best way to deal with a particular situation.

We will first describe some strategies that may help general memory problems. Then we will discuss strategies that may help people with progressive memory decline.

GENERAL MEMORY TIPS FOR EVERYONE
There are several strategies that may help people of all ages to improve memory.

Stay Healthy
Keep up your physical health. Eat a balanced diet. Get enough rest and sleep. Be as active as possible but use common sense and stop before you become worn out. General health is important to good memory function.

Relax
In general, memory is often better when people take the time they need to store and recall information. Older people process information more slowly than younger people. People should not panic when they cannot recall something immediately. They should try to relax for a moment, be patient with themselves, perhaps think about or go onto some other topic for a while, and allow the information to come back.

Allow Enough Time
It is important to plan ahead to allow for enough time to complete a thought, express oneself, or complete a task. When people are rushed for time, chances are their memory will slip. When people are late for an appointment, in their hurry they may forget something important.

Focus
People should try to focus on one thing at a time. Pay attention carefully and review the information. When parking a car, focus on the parking spot, look at the permanent structures nearby-such as a sign or storefront. Glance at the site a few times as you walk away in order to review the picture of your parked car. A person under stress or dealing with loss may find it hard to focus on one task or one idea. Professional help from a counselor or clergy can provide direction in dealing with stress, sadness, or overwhelming life events. Then focus and memory should improve.

A Quiet Place
A quiet, peaceful place is the best setting to help people store information in their memory. For example, people can re-member better when they are away from noise, such as in a small sitting room away from the television or on the back porch away from traffic noises.

A quiet place free of echoes is especially important to people with hearing difficulty. While a place of worship may be quiet, there may be many echoes that interfere with hearing. A carpeted room with curtains and upholstered furniture should be free of echoes. People who have difficulty hearing should have a medical evaluation. When the doctor prescribes hearing aids, they should be worn regularly. Other tips include:

¨Rest - It is best to be rested and fresh, not tired or upset. For example, first thing in the morning-right after breakfast when your "head is clear"--may be the time to learn a new skill.

¨Repeat It - If something is repeated many times, it is easier to remember. When meeting someone new, repeat the name aloud once and to oneself twice, at the least.

¨Say What is Done - When a task is finished, saying words out loud helps firm up the memory, for example, saying "The electric bill is paid."

¨Group Things - It is easier to remember items by putting them in groups that are alike. For example, if you need to buy milk, soda, oranges, and bananas at the store, you could group these food items into drinks (milk and soda) and fruit (oranges and bananas).

¨Imagine It - To help remember some-thing, create a picture in your mind while repeating its name. If the mental picture is strange or silly, it becomes easier to remember. For example, if you want to remember to buy cat food at the grocery store, you could imagine your cat at the store balancing a 10 pound bag of cat food on her tail.

¨Attach Meaning - Usually people remember events that are important and meaningful. It helps to think about why an event, person, or object is important and how important it is to remember. For example, going to visit a friend to celebrate the birth of a first grandchild gives more meaning to the activity when you schedule it and you are more likely to remember to attend.

¨Establish Routines - Set up a routine time for demanding activities, such as paying monthly bills the same days of the month or filing important papers every Thursday.

Emotion
Sometimes people can remember events that happened during emotional times better than those that happened at quiet times. Perhaps they are paying more attention. Maybe the event is more meaningful. If the item to remember links to an emotion, it is sometimes easier to remember. For example, it is easier to remember what happened at your birthday party than at a routine lunch meeting. Remembering events during emotional states may not be true if you are very sad. People who feel sad may be preoccupied with their thoughts. As a result they pay less attention to activities around them and have little memory of what actually happened. They may have less energy and interest in an activity. They may be unable to pay attention. For example, a person who has learned from their doctor that they have cancer will be preoccupied, not able to concentrate, and not able to remember many details about the discussion of the diagnosis. Also, they may have difficulty recalling the events that followed during the next few days.

People who have just had a car accident often cannot remember the details of what just happened to them. Someone who has lost a companion may be so sad that they are unable to pay attention to conversations or other events. Later they may not even remember important events, such as a political election or travel plans during that time.

Cues
Often it is easier to remember something from a cue. A cue is a hint, a reminder about the item or event you are trying to recall. Sometimes if one thinks about the general category, the time, or the people involved, that information will provide a cue about the specific detail the person is trying to recall. Remembering that you saw a special bird (category of animals) may trigger the recall of the word robin. Remembering a hike that occurred last spring will give a time link to help you remember you were at Ginnie Springs. Link a routine action with something you are trying to remember, such as taking medicine at mealtime or right afterwards.

Most of these means of helping memory are meant for people who have normal memory problems, such as those created by stress or by having a busy lifestyle. These tips may also help people with a mild degree of memory loss. This early stage of memory loss is called "forgetfulness." Some older people develop forgetfulness and do not progress to a more severe level of memory loss.
The next section describes strategies that may help people with different levels of progressive memory decline.

TIPS FOR MILD PROGRESSIVE MEMORY DECLINE

Memory Differences
It is important to understand the different types of memory storage because a person with severe or progressive memory loss may have one kind of memory loss and not another. For example, people with brain damage on their left side (the left hemisphere holds verbal or word memory) may not be able to remember a shopping list. Or they may not be able to remember the words in a conversation. However, they may be able to use their visual skills (the right hemisphere stores nonverbal memories). For example, they may remember the faces of people they meet at the store.

A person with a great deal of damage on the right side of the brain may not be able to remember and follow directions to a friend's house but may be able to remember conversations.

General Tips
¨Organize - Keep items that are alike in the same place. For example, keep all keys on one ring.

¨The Same Place - Make a list of items that tend to get lost and decide where to keep them. Once you decide where you are going to put items, keep them in the same place. Keep shoes by the side door or in the bed-room closet. Wear your eyeglasses or keep them on your bureau top. If you can afford a second pair of eyeglasses, keep one pair for home use and the other pair in your purse or jacket for outside activities.

¨The Same Time - Do a particular activity at the same time each day. For example, awaken and get out of bed the same time each morning. Brush or clean your teeth at the same times each day. Take your medicine at the same time each day. Try to set aside a particular day each week for special tasks, like shopping for food on Thursdays.

¨Remove Clutter - Give or throwaway odds and ends, extra end tables, many knickknacks, piles of old newspapers, broken tools, worn out shoes, pencil stubs, and anything unusable or not in current use. If you have not used it or worn it within the past year, get rid of it. Have a garage sale!

¨Concrete Cues - If somebody has problems with word memory, use concrete cues, such as visual helps, on a regular basis. A visual help, such as a picture of dishes on the door of a kitchen cabinet, may help the person remember where to find a dish. It may take time for the caregiver to make these changes, such as applying picture labels, but more time and effort will be saved over the long run.

Other visual helps include showing or pointing. For example, point to the object or the destination, such as going to the front room window and pointing outdoors to the newspaper or mailbox. Another way of cuing is to accompany the person with memory loss to the actual place and point out landmarks to remember along the way.

¨Show Them and Have Them Practice - People with declarative or fact memory problems may have good procedural (how to) memory. Instead of telling a person with memory loss what to do, show them how to do something and have them practice. For example, after they practice unrolling the garden hose, watering the plants, and rewinding the garden hose a few times, they may remember how to water the garden. Keeping busy helps a person with dementia to feel useful and it provides exercise. During these activities, the caregiver has time for other responsibilities.

Memory Aids
People who are suffering from a memory disorder may find help in memory aids that organize unrelated things, list activities and remind them of the time. A memory notebook designed for the patient's own lifestyle may be a good memory aid.

¨The Memory Notebook - The Memory Notebook can be an important memory aid. Just giving a notebook to a patient with amnesia will not help. In order for it to be helpful, patients with memory loss must be shown how to use the memory notebook. There are four major steps in learning how to use the memory notebook.
A. Selecting the Memory Notebook: The memory notebook should be the right size so that it can be carried in a pocketbook or in one's pocket, such as a shirt pocket. There should always be a pen or pencil with the notebook. The notebook should be divided into labeled sections. The number of sections may differ depending on each person's needs, but we recommend at least six sections.

1. Personal Information: This section of the notebook should have the person's name, home address, work address, telephone number, and the name and telephone number of a person to contact in an emergency. The present date also should appear here.

2. Calendar of Events: This section could be a very small calendar that has the dates and times of things to do. It should have a listing of what needs to be done and have a place where the person marks off what is finished.

3. Money / Everyday Money Matters: In this section of the notebook the person may write down how much money was spent and what was bought. There should also be a place to note how much money the person received that day.

4. Messages To and From Other People: In this section the person should write down things and messages they must give to others. Also messages that others have given them, such as phone messages, can be written here.

5. Diary: In this section the per-son could write all the activities done that day.

6. Important Names, Numbers, and Facts: In this section of the notebook, the person keeps the names and telephone numbers of relatives and friends. Social security number, the doctor's telephone number, and other important medical information may also be written in this part of the notebook.

B. Learning How to Use the Note-book: It is important to show and explain the different parts of the notebook to the person with the memory loss. After showing the person how to use the different sections of the notebook, ask questions to see if they remember how to use it. If a patient does not remember or does not understand how to use the notebook, explain it again. Ask questions until you are confident that the person remembers how to use each section of the notebook.

C. Practice Trials: After people with memory loss are shown how to use the notebook, the next step is to test them to see how well they remember. For example, the caregiver may:

D. Field Trials: Once the person with memory loss learns how to use the notebook, they should be watched during their normal activities to see if they use the notebook regularly. When the book is not used, the person needs reminding.

Memory Notebook Alternatives
Sometimes even if you teach people with severe memory problems how to use the notebook, it is hard for them to use it. In that case, teach them how to use a simpler notebook with one or two sections or to make short lists.

Computers - A computer may be an alternative to the memory notebook. Now there are small computers (personal organizers) that can replace notebooks and be used as timers. The computer can buzz and give a message. A person with memory loss will have to be trained to use these computers. You may teach how to use the computers using the same method described to use the memory notebook. Any store that sells computers will be able to tell you where to buy a pocket-size organizer computer and show you how to use it.

Reminder Notes - If the person with memory loss can read, it may be helpful to place notes around the house. For example, at the telephone a note may remind the person to put messages in the memory notebook. You may put a note saying, "STOP" on the door to remind them to stay inside. Such notes around the house can be very effective.

Timers - There are many times during a day when people need reminding. Therefore, timers may be valuable memory aids. For example, a timer on top of a pillbox can buzz until the pill is taken. Then the buzzer can be reset for the next time to take a pill. While there is no simple way to describe all situations, if a person with severe memory loss needs to do something at certain times, timers and alarms may help. Pocket computers, calculators, and wrist watches have such timers. Mechanical (wind-up) timers are sold in hardware or variety stores.

Memory Aids to Find Things
People with memory loss often forget where their belongings are stored. They cannot find things they put away. The following suggestions may reduce frustration and encourage independent living.

Labels - Word labels or picture labels help people find things. To find items easily in a closet, label the closet doors with a "coats" label high on the door and the "slippers" label near the bottom of the door.

Picture Signs - Color-coded signs or signs with pictures (not words) on doors, drawers, etc. may help them find things more easily.

Tape Pointers - Sometimes colored tape with arrows on the floor can point the way to a room. Yellow tape can lead to the bathroom and blue tape to the bedroom. The color of the tape may be the same as the colors of the room or a major color in the room, such as a blue carpet or blue bed linen in the bedroom.

Memory Box - Keep a box in a place where personal items-such as keys, wallet, eyeglasses, and other things that are used often-can be stored. A person with a memory disorder should be taught to put these things always in the same "Memory Box." The "Memory Box" may be kept by the entrance door to the house, on the bureau in the bedroom, or by the person's favorite chair.

Make a "Where-to-Find" List - This list should be a guide to find items in the house. It may be helpful to keep this list next to the "Memory Box" or on the refrigerator door.

TIPS FOR PEOPLE WITH SEVERE OR PROGRESSIVE MEMORY DECLINE

Even though there are no medical treatments for curing severe memory impairments, changing the way things are done at home can help. People with memory problems do best when they have a lot of hints or reminders to help them figure things out. Saying you are "making sandwiches for lunch time" tells them what meal is coming next. Also, telling time in terms of purpose-such as lunch time, bath time, or bedtime-may have more meaning than using numbers, such as one o'clock.

People with severe memory disorders do not function as well when there are many changes and surprises. Often they get upset when there are changes in their usual routine. Caregivers should under-stand this and see that the routine changes as little as possible from day to day.

- Reminders Help - Talk frequently about important information, such as the next thing to be done or events that are coming up. It is best to talk casually about these things in the natural flow of conversation. Try not to make the person feel foolish as if they cannot remember. Reminding them in any way of their poor memory will probably upset them.

- Keep Clocks and Calendars Handy - Leaving the curtains open during the day will help them keep track of the day-night cycle of time. At the end of each day, cross the day off the calendar so that in the morning, the new day is clear.

- Use Old Photographs and Songs - People with severe memory problems usually remember events that happened long ago. Family heirlooms, old photos or old songs from their teen years may be comforting to them and should be kept handy. Sometimes these mementos remind them of fun times and friends. These memories can calm down a restless or angry person. The person becomes caught up in the happy mood of the memento and stays that way for a while. When an old photo or song creates sadness or anger, distract the person immediately with a new activity-go to a different room, get a drink of juice, or go for a walk (indoors or outdoors).

- Limit Choices - The fewest number of items should be kept available; extras should be put away or stored. For example, a kitchen drawer should hold a few spoons and forks. The extra utensils should be stored and unavailable. In the clothes closet there could be two pairs of shoes, two shirts, and a pair of pants. Extra clothes should be kept in a separate, locked closet.

Choices could be limited to one item. As much as possible, the caregiver should honor the preferences of the person with the memory disorder. The person has the right to choose. It helps to use "Do you want" questions.

For example:
"Do you want to wear the black shoes?"

"No."

"Do you want to wear the brown shoes?"

"Yes."

- Night Lights - People with severe memory problems often have trouble at night. A night light may help them know where they are if they wake up to use the bathroom. A night light may also keep them from tripping over the edges of furniture and falling.

- Changes in Sense Systems - People with severe memory problems have trouble when their sense systems change they cannot see, hear, taste, smell, or feel as well as before. When not tuned in to the sights, smells, sounds, etc. around them, people become information-deprived and may suffer in physical or emotional health. Caregivers should make sure that people who need eyeglasses or hearing aids use them. Extra flavoring or seasoning may help food taste better. Taking time to feel the chair may help them to sit safely. Appropriate touching and hugs can satisfy skin hunger, the need all people have for contact or touch from another individual.

- Show Them How - As discussed before, a person with memory problems may have a strong procedural (how to) memory even when the declarative (fact) memory is very weak. Instead of telling a person with memory loss what to do, show them how to do something and have them practice. Many people with severe memory problems cannot remember the facts of where and when something happened (declarative memory), such as where and when they bought a shirt. At the same time, they may remember how to put on the shirt (procedural memory). Thus, people with progressive memory disorders such as Alzheimer's disease may be able to learn new skills by practicing in small steps how something is done. It may take them a few weeks to learn a new skill that someone else may be able to pick up in a few minutes. The sense of pride, of feeling capable, a bit self-sufficient and independent, is worth the effort.

- Routine Versus Change - Specific routines should be set as often as possible. The same activities done the same way everyday, such as dressing before breakfast or watering plants before lunch, are easier for people with memory loss to understand and follow. If there is a change in plans, such as a visit to the doctor or a vacation, it is important to tell and repeat the information before the event. A positive, pleasant style of approach with a smile should help. During such changes other parts of the daily routine, such as mealtimes or taking a walk, should stay at the same time to provide some stability.

Activity
People with memory problems should be encouraged to be up and around and as active as possible. They should not be left alone in a chair or in bed throughout the day. People who spend too much time in bed or sitting around become bored, depressed, and sometimes confused and disoriented; problems with memory and thinking may get worse. In addition, spending too much time in bed or in a chair may lead to poor blood circulation, skin ulcers, and infections.

Try to have people with severe memory problems do as much as possible for themselves. This is much easier said than done, since they may need 30 minutes of help to get dressed, while people without memory problems may be able to do it in 3 minutes. Letting people do things for themselves will help maintain skills for as long as possible. The activities will maintain muscle strength, healthy lung capacity, and good blood circulation.

If people with severe memory disorders become irritable or do not want to do their planned activities, caregivers should think about where there might be too much activity. Perhaps the activity is too difficult. Simple steps may help the person do the activity. For example, eating one food at a time during meal-time may help. Facing several different eating utensils at the place setting and different foods on the dinner plate may lead to confusion and frustration. In-stead one spoon placed in a serving of one food, such as stew, placed directly in front of the person, will make eating easier and more enjoyable.

Try to cut back on new activities and stick with the old routine. When people with severe memory problems become irritable, it may be due to pain or medical illness.

Travel
Traveling results in constant change. Each new place brings a variety of strange people, sights, and objects. Though the setting may change every day, keeping the same schedule will bring a sense of stability. Wake up times, mealtimes, bath times, and bedtimes should be on the same schedule as at home.

A favorite blanket, pillow, set of bath towels, or picture for the bedside table brings some familiarity to the new place. This look of sameness and the same daily schedule may help keep the person oriented.

During travel it helps to schedule only one or two special events a day. Sometimes the instability and rush of traveling lead to exhaustion. Exhaustion may result in disorientation and the person may want to return home. They may try to find their own way home and wander off from the motel or vacation spot. A Medic-Alert or wanderer's identification bracelet or necklace may help. Also helpful are a recent photo and summary of the medical history to help law enforcement officers or hospital staff.

Resting between activities helps the person relax and enjoy the trip. After spending an hour or so with a group of people, it helps to have a break for about 15 minutes. Quiet time may occur in an empty lounge, a quiet corner of a hotel lobby, or on a chair in a restroom with only one other person. This kind of break helps prevent exhaustion, confusion, wandering off, or anger outbursts. If there are special evening activities planned, it helps to keep the earlier part of the day's schedule very light and relaxed.

People who have a progressive memory disorder eventually get to a point where it is more comfortable for them to stay home. It may work out better for the family caregiver to travel alone or with a friend and to provide a paid caregiver for the person at home. Sometimes a day health care program, an adult congregate living facility, or a nursing home provides respite services, residence for a weekend, or up to two weeks at the facility for a special fee.

CHAPTER SUMMARY

Memory problems vary. People should use the type of memory strategies that fit their specific problems. In general the memory of everyone works better when the person relaxes, allows enough time to complete the thought, focuses on one thing at a time, and is in a quiet area, free from distractions. A person who is rested and fresh thinks more clearly than someone who is exhausted.

To help memory, repeat the information a few times, group things that are similar and use cues. To help store new information in the brain, create an emotional or silly picture about it or attach to it some meaning, feeling, or purpose.

People who are under stress or in a deep emotional state, such as grief, may be preoccupied and not able to pay careful attention to activities around them. Memory of such activities will be fuzzy. Sometimes professional help with stress benefits memory ability.

- Mild Memory Decline - Tips for mild memory decline include keeping like items together or in the same place and getting rid of clutter. Visual cues such as pictures that serve as labels may help people having problems with word memory. It helps to show people how to do the steps of a task and to have them practice. Memory aids, such as a memory notebook, a pocket-size computer organizer, reminder notes posted in the home or workplace, and timers can help organize activities and appointments. Labels, tape pointers, and a memory box can help a person find things.

- Severe Memory Decline - People with severe memory decline need frequent reminding, a daily routine, simple schedules, and easy choices. Activities should be varied but simple one step at a time. Regular
stimulation to the senses, seeing, hearing, tasting, smell, and touch, are important to physical and emotional health.

The caregiver should inform the person with the severe memory disorder about any changes in the routine or schedule. During changes, and especially when traveling, it helps to maintain sameness as much as possible.

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Material taken from

"Helping People with Progressive Memory Disorders: A Guide For You And Your Family, 2nd ed." (University of Florida Health Science Center). Used with permission from the authors: K. M. Heilman, MD, L. Doty, PhD, J. T. Stewart, MD, D Bowers, PhD, & L. Gonzalez-Rothi, PhD. (1999).

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College of Public Health and Health Professions, University of Florida