My loved one with Alzheimer's is getting worse. Most of the time, he does not know me. What to do?

Dear Ann:

I'm so sorry to hear that you're loved one has progressed to this stage of debilitation.

One approach to the problem of incontinence used with many patients with Alzheimer's disease is to replace ALL of his regular underwear with a brand of "Male Pull-Ups" available from Depends and other manufacturers. No discussion of the change, just tell him, here (dad, Joe etc.) put these on, they're new and clean.

If/when he has an accident, or as needed, just toss the Depends out and give him a new pair of "Pull-Ups." This will at least solve the problem of ruining his underwear and clothing, and allows you a way of saying, "It's okay, we have a new pair right here."

Having said that, I'd also say that the fact that his feet were blue and his fingers white, indicates that there are likely some circulation problems. That's assuming you're living in an area that's not in the throes of a winter snap and he's simply very cold.

His primary general practitioner or cardiologist can help determine the actual problem as one of circulation, or if it is being caused by another issue.

There is also the possibility that the person for whom you're providing care may have now reached a stage in the disease that has exceeded your ability to provide adequate 24-hour a day care. Without an onsite assessment, it's difficult to know that from what you've indicated.

In addition to the above suggestions, it may be time to talk to his neurologist, and begin making a plan for his increasing needs for full-time home care or possible placement in a memory specific care facility in the coming weeks or months, depending on his continuing rate of decline.

If you have not already done so, it may also be time to talk to an elder law attorney to plan for the expenses related to long term care in a facility.

Depending on many factors - his having a long term care insurance policy, personal assets and total net worth etc. - you want to know and plan ahead for a time when he may have to have 24-hour in-home care or requires placement in a full time care facility if/when his needs exceed your own ability to provide those services and care.

Both you and he are seeing some of the devastating results of Alzheimer's disease and aging. The steps you can take have to be twofold: (1) be sure he continues to receive the proper level of care; (2) take proper steps to take care of yourself so you don't become a casualty of caregiver burnout.

There are several aspects of both the disease and his care in play here. Talking to the Alzheimer's Association or a geriatric care manager may offer you additional ideas and suggestions to help you deal with a growing number of typical Alzheimer's problems.

I wish you well in you efforts.