Learning New Tasks

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ASK DR. MINDY

MINDY KIM-MILLER, MD, PhD
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Question:

My father has had colorectal cancer & had his rectum removed almost 3 weeks ago. He’s 83 with Alzheimer’s. We were assured from all surgeons & doctors that his quality of life will be improved, and that he WILL be able to take care of his colostomy bag. That’s not happening. Do you know of any helpful ideas for taking care of him & teaching him to care for his self? He’s becoming terribly depressed with his failures. The American Cancer Society had no resources or advice for an Alzheimer’s patient w/cancer. Do you have any advice?

–S.K.

Answer:

Dear SK,

You raise a very good point about the difficulties of trying to help people with multiple health issues to take care of themselves. It can be very difficult for someone with Alzheimer’s to learn new self-care tasks. Your father’s ability to learn depends on his stage of Alzheimer’s disease as well as the teaching approaches of his caregivers. His illness may have progressed so far at this point that he may not be able to learn new tasks. On the other hand, he may be able to learn some simple tasks if taught using the right combination of approaches. You may need to try various strategies to help him learn.
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Remember to be patient and encouraging as you try these various strategies until you find the ones that might be effective. Properly caring for a colostomy bag can be a challenging task, even for individuals without Alzheimer’s, so set realistic expectations and try not to be disappointed if he cannot master the entire task perfectly.

Try breaking up the task into simple steps, and teach him just one step at a time until he can master each part. For example, first show him how to safely remove the colostomy bag. If he can’t do it by himself, use gentle hand-over-hand guidance to show him how to do it. Then have him repeat that step until he seems comfortable doing it by himself. Then move onto teaching him how to cleanse the colostomy area. Again, provide cues and guiding as needed. If he cannot master that step, then try teaching him another, simpler step, such as attaching the new colostomy bag. Start by teaching him the simpler steps first and gradually advance to harder steps. If he is able to put all the steps together to complete the entire task, that would be ideal. But if he cannot perform the entire task, then praise him for what he is able to do.
Try to have him do as much as he can, but don’t be disappointed if he cannot perfect the entire task. Even if he is able to help with just one or two steps in caring for his colostomy bag, it will help his self-confidence. Try to be encouraging and praise his efforts, even if they fail.
Organization is important. Have all the necessary items ready to use, but try presenting only one item at a time when he needs it. Having too many items out in front of him at once can be overwhelming or confusing. As he becomes more capable, you may be able to put out several items at a time in the order that they are needed. But start by handing him one item to use at a time.

Use simple terms when explaining the steps. Give only one instruction at a time just before he needs to perform it, and then give him time to understand and respond.

Slow down the task. Do things slowly so that he has time to watch, imitate, or attempt. Try to let him take his time and assist as needed without rushing him.

If he is able to perform other activities of personal care largely by himself, then try to present the care of his colostomy bag in similar terms to his other activities. Drawing analogies to other activities that he has mastered and presenting the similarities in required motions may help him to learn the new task.

Another thing to consider is consulting a healthcare professional about his depressive symptoms. If your father is indeed depressed, it can decrease his motivation and concentration, which will reduce his ability to learn. In essence, depression and failure feed each other. So treating any depression can improve his ability to care for himself.

Lastly, keep in mind that even if he does learn to care for his own colostomy bag at some point, his ability to perform the task can fluctuate from day to day. As Alzheimer’s progresses, his memories and abilities will fluctuate from time to time, and his recent memories will be lost before his distant ones. So he may forget how to care for his colostomy bag shortly after learning how to do it. Nonetheless, it is important to encourage him and be supportive.

Dr. Mindy Kim-Miller is a trained medical physician who provides useful, but general answers to questions provided by online visitors. While Dr. Mindy can not provide specific medical advice or services, we hope you find her responses useful in your personal education. All information is provided for informational and educational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. If you suspect you have an illness or disease, or a health related condition of any kind, seek professional medical care with an appropriate health care professional immediately. Do not postpone or delay seeking treatment or disregard professional advice based upon the general answers provided by Dr. Mindy. Dr. Mindy’s advice is not intended to substitute for a visit to your personal physician or other qualified health provider. Any specific medical concerns or questions you may have should be directed to your personal physician or other qualified health provider.

 

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