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Tuesday, September 24, 2013

Alzheimer's Care, the Importance of the Early Morning Wake Up Routine


The daily routine gives a person living with dementia  a sense of homeostasis. A sense of stability in their life.

Bob DeMarco
Alzheimer's Reading Room

Alzheimer's Care, the Importance of the Early Morning Wake Up Routine

Homeostasis, a system that regulates its internal environment and tends to maintain a stable, relatively constant condition.

In simple terms, a process in which the daily environment is kept stable.

The description above applies to my use of the term homeostasis as it applied to our daily living routine.


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After years of floundering around, I finally concluded that the only way I was going to be able to accomplish my caregiver mission was to introduce a systematic routine to our daily life.

The "our" in this equation was my mother, Dotty, the person living with dementia, and me, Bob, the Alzheimer's caregiver.

Prior to the installation of the "patterned" routine I had been fighting a long list of Alzheimer's wars. The list is too long to mention but did include: the early morning negativity, the poop - e war, the pee pee war, the shower wars and the routine use of the word No.

For now, lets focus on the importance of the early morning wake up routine.

Subtitle: How to get the day off to a good start.

Years ago, my mother would wake up in an immediate state of confusion and angst. As soon as she woke up she would start saying loudly, Bobby Bobby, where are you?

I could clearly hear the fear, confusion, and worry in her voice.

The fear, confusion, and the angst of being alone, or maybe abandoned. The sound of my mother's voice did disturb me, and it then filled me with a feeling of angst.

A feeling of trepidation that our day was getting off to a bad start.

After a while I thought, I guess if I woke up and I didn't know what day, month or year it was, or couldn't remember what I did yesterday, I would probably be confused and scared.

What I am going to describe didn't happen overnight. I had to piece it together until I reached the point where I came to believe I was accomplishing my mission -- creating a safe, secure and understandable environment for Dotty.

I knew I was making real headway when Dotty started saying immediately when she woke up, YouWho I am awake you know, instead of Bobby, Bobby, Where are you?.

Dotty would continue to say YouWho when she woke up until I acknowledge her. If I don't acknowledge her quickly she would start to say negative things and the angst in her voice returned.

When Dotty sent me the first signal of the day, the YouWho, I immediately respond by letting her know I was home, and I was on my way to her.

I come up on Dotty from the right. As soon as I reached her, I put my left hand on her wrist and held it, and I put my right hand on her elbow. I would hold both gently.

This is called anchoring. More or less, it brought Dotty into the now, and gave her an immediate sense that all is well.

Keep in mind we were attached by touch.

I would ask Dotty how she was feeling or a simple morning question of that nature. I made sure I listened to the strength in her voice. Strong voice good, weak voice not so good.

I started by talking about how it was a nice day, or how we were going to have a nice day, I usually put my head on her head, if not, I rubbed her head or back with my right hand. I continued to hold her wrist.

Attachment, tactile communication (touch), a low calm voice, and positive reinforcement are the keys. Don't go negative at the wake up no matter what is happening.

Next I moved Dotty to the kitchen table. We are attached all the way until she sits down.

The first thing I did was give her her thyroid medication. This medication requires her to fast for an hour in order for the medication to work effectively. Did you get the thyroid checked by your doctor?

Next, I pick the newspaper apart and put it in front of her so that the front section is first and the Accent section is second. The Accent section contains the recipes, comics, and crossword puzzle.

I asked Dotty to tell me the day and date. I usually have to tell her to look at the top of the paper, sometimes I have to point to the day and date.

Everyone needs to know what day it is. This includes persons living with dementia. If they can't do it on their own, you must, must help them discover this information. I feel strongly about this.

Sometimes we discussed the front page of the newspaper, sometimes we discussed the food section, or a recipe. I always asked Dotty to read to me from the newspaper. If I asked what does it say, we didn't get far. I had to ask, read it to me.

By now we are fully engaged. I have Dotty attached to the world and into our normal daily routine.

Do you have a normal daily routine?

The daily routine gives a person a sense of homeostasis. A sense of stability in their life.

You can develop your own early morning routine. Don't be afraid to experiment. Try to figure out what works best. You'll know when you get there.

Here is the good news. Your Alzheimer's patient will feel more secure and happy.

Here is the best news.

You'll feel better about yourself, you won't get all stressed out at the beginning of the day, and you will be on your way to the world, Alzheimer's World.

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