How to Care for Patients or Clients with Multiple Sclerosis

Multiple sclerosis¹ (MS) is an autoimmune disease that has the potential to cause debilitating problems with the spinal cord and brain.  Although it is usually diagnosed in people ages 20 to 50, CNAs and HHAs will likely need the knowledge and training to properly assist people in your care, whether employed in a client’s home or in a care facility.

It is also very likely that family and friends will play a part in the long-term care of their loved one. So, it’s important to share your knowledge with family and friends so that they, too, know how and when to provide practical assistance.

As with any disease, MS patients will sometimes feel isolated and alone.  Encouraging your patients to build and grow a strong network of family and friends, and/or other residents in their care facility will help them thrive.  Taking on tasks when you patient isn’t able, like helping with their medications, or walking alongside them to dinner are all things you, as their caregiver, can do to help them meet the challenges of everyday life.

How Does a CNA or HHA Recognize MS in Their Patient?

The signs and symptoms of multiple sclerosis² can be very different, depending on the person.  Observing your patient/client for any changes in their condition, or if they begin showing another symptom not yet documented is imperative for their overall health, and will help reduce the risk of any further complications. But remember, the symptoms of MS come and go, so encouraging patients to follow their doctors orders and watching for flare-up will go a long way in helping your patient(s) cope.

Common symptoms of multiple sclerosis that you may see in a regular workday, include:

• Slurred speech
• Lack of coordination
• Unsteady gait
• Tremors
• Pain or tingling in a part of the body
• Prolonged double vision
• Partial or total loss of vision, usually in only one eye, associated with pain in the eye
• Numbness or weakness in one or more extremities, usually on one side of the body
• Tiredness
• Bowel or bladder difficulties
• Dizziness

Observing and Documenting the Course of the Disease

Assessing a patient with MS begins with the initial observation of the patient, and includes observing his or her ability to move (walking, walking with assistive devices), including balance and coordination, their hygiene, and their speech. Patient interviews provide the greatest information to guide caring for the patient with MS. Throughout this process, CNAs and HHAs can discern if symptoms are constant or intermittent and how they affect the lives of their patients, at home or in a care facility.

CNAs and HHAs caring for patients with MS need a thorough understanding of the various types of MS and should be familiar with the typical progression of each type in order to initiate patient education for patients and their families, and provide information about MS to help patients and their family develop a realistic picture of the disease, the benefits of treatment, and expectations related to its management.  CNAs and HHAs can also help patients and their families adopt a healthy life-style, and maintain a positive and hopeful perspective.

About 50-70 percent of individuals with multiple sclerosis will eventually develop a steady progression of symptoms, and over the years, a patient’s condition can change a lot.  Depending upon the advancement of the disease, people suffering from MS may need part-time or full-time help at home from family and friends or they may need to hire a HHA to come into their home.  It’s likely that at some point, a client will move into an assistive living facility or into a nursing home.

If so, try to be understanding. Very possibly, they feel they are losing control and may become angry or fearful. And then people may feel guilty or inadequate if their MS progresses in spite of their best efforts to reduce their stress levels.

No two people or families living with MS react to the disease in exactly the same way or face exactly the same challenges. Help your patient, as well as her or his family to become actively involved in their treatment. Help families to seek out good information about MS and its management. Because the more they know, the more prepared they will be to make the best choices for their loved one.

And, If you notice an increase in behaviors, ask the nurse about a special meeting to address your concerns. A team approach is always best. Now your good documenting will come in handy.

Understanding Possible Complications of Multiple Sclerosis

Understanding that people with multiple sclerosis can have complications will help you understand the challenges, as well as be there with an out-stretched hand or an encouraging word when they need you.  A few of the complications of MS, include:

• Epilepsy
• Forgetfulness, mood swings, and other mental changes
• Bladder, bowel, or sexual function difficulties
• Paralysis, especially of the legs
• Spasms or muscle stiffness
• Emotional breakdown and depression

Each of these complications may call for a different response. If you patient is depressed, you may need to engage them in conversation or encourage them to join in activities.  If you notice spasms or muscle stiffness, a massage may be just what they need.  You, a CNA or HHA will perform a variety of basic duties that are important for the patient’s comfort and overall wellbeing.

Home Treatment of Multiple Sclerosis – Home Health Aids

Families of patients with multiple sclerosis need to find ways of coping with the emotional and physical aspects of the disease.  The degree of home care can vary from person to person, and may include hiring you, their Home Health Aide.  A HHA can do things around the home to make life easier, and eliminate other health risks, including:

• Become an advocate for your patient by explaining the signs and symptoms of MS, what to expect as the disease progresses, and how to best help their loved one.
• A HHA may suggest building portable ramps to help patient’s go up steps or get around easier in a wheelchair
• Replace doorknobs with level-style handles to make opening doors easier
• Provide a stool in the kitchen for your client to sit on when preparing a meal
• Tell you clients about assistive tools, such as grabbers that help to reach items on higher shelves, or a raised chair that helps lift them out of the chair from a seated position.
• Advise the family to add handrails to the sides of stairs, and look into a stair lift system
• Install night lights throughout the house
• See if your clients bed can be raised to make it easier to get out of bed
• Recommend a bed-side commode
• Remove rugs to avoid falls
• Suggest a raised toilet seat and a tub bench
• Offer to show them options for walkers, wheelchairs and other mobility devises

Multiple sclerosis can be treated by physical or occupational therapists who travel to a client’s home to teach patients stretching and strengthening exercises. PTs and OTs can give you valuable information about how you too can help clients/patients while in your care.

Treatment in a Care Facility – Certified Nursing Assistants

When family and friends can no longer care for a loved one with MS, or living at home is no longer an option, assistive living or nursing home facilities can be the answer. CNAs job duties will vary according to a patient’s symptoms.

Many patients with MS will be mentally alert, and are often younger than other residents.  However, they may be more prone to depression, and more physically dependent.  As a result, CNAs (and all staff) may need additional training and resources in order to provide the very best care and treatment.

While some symptoms of MS are seen in other disorders the severity and the very nature of MS symptoms present a unique challenge to nurses and CNAs.  It is important that you are aware of the unique ways these symptoms present in persons with MS, their impact on day-to-day life, and potential treatments and strategies for managing patients’ care.  It’s also necessary to know that infections can be extremely serious⁴ in advanced MS. Fever and/or a significant increase in symptoms like fatigue, pain, swallowing problems, or vision changes are usually signs of infection. It is critical that whenever an infection is suspected there is prompt medical attention and treatment.

As the ears and ears of nursing staff, the client’s/patient’s family, the patient’s doctor, and as an advocate for the patient, you not only care for their needs on a daily basis, but also provide emotional support when needed.

Balance: Most patients with MS have balance and/or walking problems.  It is very important to closely supervise your patients when transferring or walking.  You may use transfer belts to help with transfers and walking, or simply lend an arm for balance.

Incontinence: Many patients with MS have problems with incontinence and bladder dysfunction. Although common, proper management is necessary to prevent UTI’s and other infections.  Suggesting simple ideas like adding cranberry juice to their morning routine can help ward off bladder infections. Doctor-prescribed medications can also prevent infections, as can limiting caffeine and caffeinated beverages.

Constipation: Many patients suffering with MS also suffer with constipation, which may be in part due to a lack of exercise and medications. Suggesting you patient use stool softeners and laxatives will help keep them regular.

Cognitive Impairment: Patients with later-stage MS also have some cognitive impairment, such as memory loss, lack of concentration, etc. These issues present a significant challenge to care workers.  Putting things in writing, repeating information if necessary, and advising patients to use a calendar can all help.

Fatigue:  Fatigue plagues many patients with MS.  As a CNA you should be on the look out for any increase in fatigue, as it may be the first sign of an infection.  Try to schedule times of rest between social outings or meals.

Pain. Pain is also very common with MS.  Many people with MS experience tic-like pains or sharp stabbing pains, particularly in the face. Be aware that is it very common for MS residents in long-term care facilities to “become addicted” to painkillers. Monitor and document pain medication use, and report any changes in behavior to nursing staff.

Spasms, speech impairments, muscle weakness, and swallowing difficulties, and many other problems are also very common in patients with MS.  Having knowledge about MS, how it presents itself in patients, its progression, and the psychological and emotional issues⁵ that can arise in patients with MS will help you help residents to maximize their independence, mobility and overall quality of life.

MS affects the patient, his or her family, friends, and caregivers.  It can completely change a person’s lifestyle, and cause depression and anxiety.  Caregivers, whether family, a HHA or a CNA may be required to continually increase a patient’s care because of the debilitating nature of the disease. This includes facilitating treatment and symptom management, promoting and enhancing function, and supporting a favorable quality of life in patients with MS, and their families.

References

1. Mayo Clinic; AskMayoExpert. What is multiple sclerosis? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
2. WebMD; Recognize Multiple Sclerosis Signs and Symptoms; reviewed by Richard Senelick, MD; Nov. 26, 2015
3. Health; Health.com; 12 Surprising Factors That Up Your Risk of MS; Denise Mann
4. National Multiple Sclerosis Society.org; Nursing Home Care.pdf
5. National Multiple Sclerosis Society [NMSS], 2002

Multiple sclerosis has no cure.  There are treatments and therapies, however, that can improve the speed of recovery from flare-ups of the disease and can modify the course of the disease or help to control symptoms.

MS is much more common in females.

MS can affect people of any age, but is most commonly diagnosed in people between the ages of 20 and 50.

Older adults with MS have been found to have “significant disabilities” and accelerated rates of disability progression (compared to younger individuals with MS).