Alzheimer’s

Optimism amongst the chaos.

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In the book, Gabby, by Gabrielle Giffords and Mark Kelly, Congresswoman Giffords’ husband, Mark, provides statements about optimism that have greatly encouraged me.  Here are just a few:

  • “I saw how optimism is a form of therapy and hope is a form of love.”
  • “Doctors at TIRR, the rehab hospital, told us that our optimism and encouragement could make a great difference in Gabby’s recovery…”
  • “To be of help to a brain-injury patient, we were told, families need to find a way to balance pragmatism and optimism.”

In a Time Magazine article published December 13, 2011, Congresswoman Giffords addresses the struggles she and her husband have endured as they continue to adjust to the “new normal” brought about as a result of a bullet that pierced her brain on January 8, 2011 when she was reaching out to her Congressional district in Arizona.  So many of us have new normals as we walk, or fall, head first into Baby Boomerism.  This normal may involve a loved one who has a fatal or debilitating illness.  This new normal may be characterized as our own bodily/physical struggles inherent with our age.  Each of us have some sort of chronic something-or-other that inhibits our ability to function at 100%.

What is the chronic something-or-other that inhibits your ability to function at 100%?

The above question is a rhetorical one.  Neither myself nor the public need to know the specifics – but you know the specifics and you’re the one making long-term adjustments as a result.

What processes do you follow to unearth the optimism that exists somewhere in your psyche? How do you overcome your personal challenges so that you end most days victorious, rather than defeated?

My wonderful sister, on my left, and I at a Napa winery - tasting wine of course! Cheers!

For me, it’s acceptance.  For me, acceptance doesn’t mean giving in or giving up; rather, acceptance means being o.k. with how things currently are and finding ways to succeed within that new normal.  This mentality or attitude is more optimistic than you may think.  Again, for me, I  decided to allow optimism to nurture the hope that oftentimes is buried deep within me.  Things could very well change for the better –  which doesn’t have to be defined as being 100% problem-free.  Nope.  If I garner optimism at the start of each day, I’m making a conscious and aware decision to acknowledge and celebrate even the smallest of victories that might occur in the next 24-hours.  If I wait for a humongous, star-spangled mega-victory, I may wait forever.  Instead, I attempt to be aware of even the smallest improvements/goodnesses in my day so that my life is filled with many victories to celebrate.  The previous sentence says that “I attempt” to garner optimism throughout my day.  I don’t always succeed – but I try.

What small victory can you celebrate today?

What works for you? The rest of us would love to celebrate that victory with you.

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Preserving your loved one’s dignity.

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The more a person becomes dependent on others, the more protection he needs.  A person with dementia needing the assistance of others is considered a vulnerable adult.  He can’t defend himself or speak up for himself.  He can’t demand exceptional care, courtesy, and respect.  As his advocate – that’s where you come in.  When he doesn’t have a voice – you step in to be that voice.  Your reward will be great if you succeed in doing so.

Part of what I do in my working life is to advocate for vulnerable adults by doing what I can to promote dignity and quality of life for those I have the privilege to serve.  As a family member, or good friend, to an adult with dementia, your task is a monumental one because along with your caregiving role, you must also excel at the task of advocacy.   In my blog article, “Be an Advocate for your Loved One” posted on this blog November 14, 2011, I discuss the various ways in which you can advocate for your loved one.  This current article is the last article in my “Understanding Alzheimer’s and other dementia” series and it addresses the issue of dignity and privacy.

My dad in the 1960's; a former Marathon runner

As those of us who have, or have had, loved ones with dementia we know without a shadow of doubt, that our loved one’s current condition does not reflect the pre-Alzheimer’s/dementia person.  A grandmother who previously never spoke the “F-word” now speaks it as though it were just another word in her vocabulary.  A previously modest and distinguished gentleman now routinely removes his clothes in front of others, and/or may be inclined to grope his caregivers or other residents.  A former globally recognized businessman, sought after for his abundant knowledge in his field, now needs others to feed him and has lost the ability to string a meaningful sentence together.  Our loved one’s new normal is shocking to those of us who are close to the person with dementia, and completely foreign to those who are not.

Keeping people informed about your loved one’s condition.

Those who definitely have an attachment to your loved one: friends, coworkers, close neighbors, and of course family members, will probably appreciate knowing what’s going on with him.  It’s important to use discernment when deciding who needs to know – and who doesn’t.  And thanks to e-mail and texting, we can update people immediately and thoroughly with no need to pick up the phone.  That’s truly a bonus, isn’t it?  You’re already stressed and emotionally drained by your situation so having to conduct numerous telephone calls and provide the same update to several people would be prohibitive at best.

But with the ease of e-mail comes the temptation to be too thorough in the e-mail missive.  You’ve already discerned who needs to be kept updated; now you need to use judgment on how much you say and how you say it.  Does your neighbor really need to know about your husband’s incontinence?  How would it benefit your mother’s former coworkers to learn that their former Marketing Executive now drools throughout the day and can no longer feed herself?  More to the point – ask yourself this question: How would my spouse/parent/partner/sibling/friend feel if they knew I was providing all the gory details of their dementia progression to those near and dear to them?  The answer, I believe, is obvious.  If they could, your loved one would say, “Please don’t let everyone know what I’ve been reduced to.”  Showing respect for your loved one includes protecting her privacy, and thereby her dignity.  And I’ll tell you from experience – those on the receiving end of the information would rather you be brief and not overly descriptive.

Celebrate the uniqueness of your loved one.

My dad in the 1960's "fixing" the toilet. He always was a jokester!!!

Your loved one is not just some generic living and breathing person in the Early, Middle or Late stage of Alzheimer’s.  He may not be able to do everything he previously could – maybe he’s not even able to speak – but you can still celebrate him as a human being.  Everyone mourns what’s been lost; hardly any one celebrates their loved one’s remaining attributes.  I learned a lesson from my father during the middle stages of his dementia.  I was quick to finish his sentences, or rush him along by answering people’s questions for him.  My dad didn’t have to use words to express his displeasure when I did that.  He slumped in his chair, looked at me, and let out an exasperated sigh.  I stopped right then and there and made no further attempts to rush him as he conversed.  Doing so would take away one of the abilities he still had – talking and getting his point across.  It may have taken him a long time to complete his thought, but he still had the ability to do so.  Please don’t take away the remaining vestiges of your loved one’s independence and abilities.  If you feel compelled to feed your loved one just because they take a long time to eat their meal, you’re training them to rely on you for that assistance when they could have been doing it on their own.  Who cares if it takes 60 minutes instead of 15 to finish a plate of food?  If they’re still able to feed themselves – celebrate that ability.  Don’t take it away for your own convenience.

Walk into their reality – don’t force them to enter into yours.

We’ve all experienced conversations with our loved one wherein he or she talks about things that didn’t really happen, although they are convinced that they did.  What’s the harm in agreeing with them and going along with their story.  Your wife says, “Didn’t you enjoy that trip to the Grand Canyon we took with the kids a few years ago?”  O.K. – first of all you don’t have any children, and second of all, you’ve never been to the Grand Canyon.  Instead of trying to convince her of what’s real – and making her feel bad/ashamed in the process – talk about the great view, or how all the kids fell asleep in the car and missed the entire gorgeous spectacle.  I can guarantee that if you change your paradigm regarding this development, both you and your loved one will be better off.  The Alzheimer’s Association has a great adage that they offer us caregivers to help us along the way.  If you don’t insist – they can’t resist.  I challenge you to go with the flow instead of trying to paddle upstream.  Don’t cause contention.  A little make-believe goes a long way and harms no one.

AARP magazine reviewed the book Dancing with Rose: Finding Life in the Land of Alzheimer’s by Lauren Kessler. This memoir by Ms. Kessler is portrayed as “an  Alzheimer’s tale that’s warm, uplifting, even hopeful – qualities not normally associated with the illness.  This odd dichotomy – joy atop a ravaging disease – makes this book a refreshing standout.”  Alzheimer’s and other dementia have the ability to peel away a person’s former mask to allow what’s underneath to surface – pleasant or not.  What Ms. Kessler learned in her journey with her mother is that “if viewed from a different perspective, Alzheimer’s is not the end of personhood.”

Yes – dementia changes who your loved one is.  It oftentimes reduces him or her to childish, and then infantile behavior.  But they are still a person.  They are no less worthy of your respect and your compassion.  This hardest task of your life will end some day.  In the interim, may you be merciful to your loved one and may those with whom you are associated support you along the way.

Long Distance Caregiving: Part I

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Numerous authority figures are entrusted with your loved one’s care – most of them a fraction of their age.  If you can’t be a physical presence for your loved one what will you do to bridge the gap between physical absence and an effective long distance presence?

My mother and my daughter, circa 1976.

My father was diagnosed with Alzheimer’s at the age of 84 and died in 2007 at the age of 89.  By the time of his diagnosis he had been living in a Continuing Care Retirement Community (CCRC) for seven years.  His wife, my mother, died a month before they both were to move to this CCRC located in Oregon state.  My mother was truly looking forward to the move with my dad but on September 24, 1994, she was granted the wish that she had thrown into the universe many years earlier – that when her time came, she wanted to die in her sleep.  My father still moved to the Oregon CCRC because at the age of 77, he knew he still had a valid reason to move there.  Both he and mom didn’t want to be a burden to us three children, so moving into a retirement community that would meet all the needs of his aging body and mind was dad’s gift to us.

Dad, myself, and his wife Barbara on his 87th birthday.

A few years after my mother’s death, dad married a resident of the CCRC and they had a wonderful late-in-life marriage.  Dad’s wife, Barbara, died from complications of Parkinson’s in 2003 so once again, dad became a widower, but this time his biggest challenge was that he was in the early stages of Alzheimer’s disease.  He was still able to live semi-independently in an assisted living apartment at the complex and he was able to perform his activities of daily living (ADLs.)  Of us three adult children, the job of being dad’s caregiving team leader quite naturally fell to me.  I had worked in the senior care industry for several years so I was quite familiar with caregiving lingo and body frailties, not the least of which was Alzheimer’s and other dementia.

Dining room at my father's facility.

Initially, the miles that separated us wasn’t all that challenging.  He was still active, was fully capable of getting himself up in the morning, taking his medications, getting to the dining room, etc.  Us children would call dad frequently – and he still had the ability to call us – and we continued our visits throughout the year and although his dementia was obvious to us, we knew he was in good hands and that he was functioning quite well.  The staff was very attentive to him and if they had concerns, as his health care representative and financial power of attorney, they kept me abreast of the latest, the greatest, and the ever-increasing not-so-greatest.

The not-so-greatest happened one frightful evening.  Dad called me telling me that he felt very agitated and he couldn’t stop walking around his apartment; he couldn’t settle down; he didn’t know what was going on.  I asked him if he had recently taken any medication and he replied, “Just some cough syrup.”  “How much did you take?”  “I don’t know.”  So while I had my father on my home phone line, I called the front desk of the facility on my cell phone and told them that my father was having an emergency in apartment #94 and a nurse needed to get there immediately.  I kept my dad on the phone and told him that a nurse was on the way to see him and that he would be taken care of very soon.  The nurse arrived quickly, and the emergency was averted.

Bottom line?  We now knew that dad was no longer capable of managing his own medications.  He took way too much cough syrup that evening and it caused his heart to race, resulting in extreme agitation.  This precipitating event was the start of his noticeable decline and medication management became the first ADL for which my dad needed assistance.

The above example barely scratches the surface of what many of you are dealing with.  Your long distance eyes and ears seem thoroughly ineffective and you’re concerned about your loved one’s well-being.  There is hope for the long distance caregiver.  It’s not the same as being there, but this hope somewhat bridges the long distance caregiving gap.  Part II of this article, published December 4, 2011, addresses some practical steps you can take to help in your caregiving journey.

Denial: Roadblock to better health and better care.

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STATEMENT:  Carol’s having a little problem with her memory.
Initially this might be an accurate statement.  Two years later, it’s a euphemism that doesn’t benefit anyone, the least of which is Carol.

Imagine denying a person’s cancer diagnosis.  There’s no need to treat it.  I just have an uncontrolled division of abnormal cells in my body.  It’s not that bad.  It’s early in the diagnosis anyway and I’m not even experiencing any major symptoms.  I’ll do something about it when it really gets bad.  Ill-advised, right?  Most people would not follow that path.  But Alzheimer’s disease, and other dementia, are no less serious.  As a matter of fact, cancer isn’t always fatal, but Alzheimer’s is.  There is no cure and no potential for one at this time.

Most people would spring into action upon receiving a cancer diagnosis: learning as much as possible about it; taking measures to curtail  the cancer’s effects on their lives.  The sooner one does something about it, the better the chances of successful treatment.  For some reason, when a person receives an Alzheimer’s diagnosis there’s a self-inflicted stigma attached to it; as if the afflicted person brought the condition on themselves.  This is an unfortunate perception and one that should be put to rest.  Whereas clinical depression or mental illness used to be a taboo subject, those conditions are now more readily accepted in the public eye.  Alzheimer’s must be brought out into the open, especially as it affects you or a loved one.

THREE MAJOR REASONS WHY ONE SHOULD ACT ON AN ALZHEIMER’S DIAGNOSIS:

  • The window of opportunity to start early drug therapy can be a very narrow one.

The time to seek medical assistance is when symptoms become fairly consistent and more than just a “senior moment.”  A thorough medical exam should be conducted to rule out any cause other than dementia.  Some medical conditions and/or medication usage can mimic cognitive decline.  All the more reason to act early to rule out what might be a readily fixable temporary condition.

If after the thorough medical exam a cognitive workup is warranted, you’ll have a defined cognitive baseline and can start treatments and/or make adjustments in the household that will minimize the disease’s impact on your lives.  Now you’re in the driver’s seat, regaining some amount of control over the disease.

  • Those close to you need to be informed.

As mentioned in an earlier post, “Caregiving: The Ultimate Team Sport” (article located in the “Caregiving” tab) you can’t assemble a care team if you’re ignoring the needs and challenges facing you and your loved one.  You’ll be amazed at the relief you’ll feel knowing that you’re not battling this disease on your own.  Let your family and close friends know early on what you need from them.  Partner with them to become a formidable force upon which you can rely.  You need support and it’s available from several resources.

  • Join a local Alzheimer’s Association support group.

The Alzheimer’s Association lists support groups in most geographical regions that should prove extremely helpful to you.  Type in your zip code in the “Find Us Anywhere” upper right area of their website and you’ll be connected with the Chapter located nearest to you.  Within that local Chapter you’ll then be able to search for a support group by typing in your city, county,  or zip code.   You’ll find groups for family members who are attempting to support their loved one who has received a dementia diagnosis.  You might also find support groups for patients who are in the earliest stages of their illness.  Both groups can do much towards providing you with confidence and hope when none can be found.  These groups become a practical resource into which you can tap to benefit from others’ experiences in managing the disease.  If by chance there is no nearby Alzheimer’s Association Chapter, check with your local hospitals, community colleges, senior centers, and the like as they oftentimes hold groups that are facilitated by trained professionals.  These alternative groups are very adequate options when no other groups are available.

If you or a loved one has received an Alzheimer’s/dementia diagnosis, you’ve just entered one of the most difficult chapters of your life.  You deserve all the support and medical attention you can get.  Ignoring the condition doesn’t make it any less real so please take the steps needed to manage this stage of your life effectively.

The next article in this “Understanding Alzheimer’s & other dementia” series is : “Driving with dementia: the dangers of denial.”

Understanding Alzheimer’s & other dementia

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There are diagnostic tools in place that try to make sense of the symptoms of Alzheimer’s and other dementia; some are conclusive, while others are simply an educated guess because knowledge of this disease is evolving day by day in the medical and scientific fields.  And for certain, no two people with the disease have the same manifestation thereof.

Whether or not an actual diagnosis is presented, you as family members, or perhaps as the patient, are struggling with this new reality and are attempting to carry on as normally as possible.

In the days ahead I am going to submit four articles addressing some of the challenges inherent with this disease.  I am not an expert – I have no PhDs and no medical degrees – but what I do offer is advice gleaned from my own practical experience and from that of those with whom I have been fortunate to be acquainted.

The four articles will be as follows:

  1. Denial: Roadblock to better health and better care.
  2. Driving with dementia: the dangers of denial.
  3. Long distance caregiving (provided in two parts.)
  4. Preserving your loved one’s dignity.
My wonderful brother Don, and our dad in June 2005, a year after dad's Alzheimer's diagnosis.

As Charles Darwin once said: “It is not the strongest of the species that survive, nor the most intelligent.  It is the one that is the most adaptable to change.”

I hope that ALL of us will have something to offer as these four articles are presented.  I covet your input and hope that you feel free to provide it.

Transportation challenges with Mom and Dad.

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Because of your flexible work schedule, you are the designated driver when it comes to taking Mom and/or Dad to doctor appointments.  Well, the older your parents get, the more feeble their bodies, and the more potential for aggravating factors such as cognitive decline.  What should have been a 2-hour outing has become an all-day event.

Remember the good ol'days? Neither do I.

I’m quite certain that many of you reading this article have struggled in your efforts to drive Mom or Dad to their many doctor appointments.  Getting Dad into the car is one thing, but getting him out?  My goodness – through no fault of his own, he’s forgotten the process and you don’t have the strength to lift him out.  With Dad’s cognitive decline, his understanding of what it means to sit or stand on command has decreased.  The ol’ “Ally Oop!’ maneuver or the “1-2-3 Stand!” command just won’t work any more.  What’s a person to do when you are not able to exert the strength to facilitate such an action on your father’s behalf?

Dad and I on a picnic, Spring 2005.

When I visited my father in the long-term care (LTC) facility in which he lived, my goal was to get him out of the facility as frequently as possible.  I took him on picnics, on walks around a park’s perimeter, up and down the aisles of a supermarket – anything to provide a change of scenery for him.

As my father’s dementia increased, however, these outings became less and less practicable.  I was not blessed with a strong back so my attempts to lift him out of the car or onto a park bench were met with horrendous failure.  I grieved the cessation of these activities but I just couldn’t manage my father’s body any more.  And not being able to go on these outings really curtailed the enjoyment of our visits together.

Had I lived in the same town as my father, another person could have accompanied me who was capable of assisting with the transfer of my father in and out of the vehicle.  Unfortunately, my father lived in Southern Oregon and I live in the Seattle, Washington area so calling upon a friend to go along on these outings was not an option for me.  If you, however, live near your loved one, do yourself, and your loved one, a favor by bringing another family member or a friend who has the ability to assist with the mechanics of transporting Dad on outings.  Not only will the physical assistance help, but you’ll have someone else with whom to visit when the conversation with Mom or Dad lags due to cognitive decline – or hearing difficulties.

Another benefit of having an additional person with you is that you are introducing your friend to the unavoidable process of aging.  This may sound like a negative benefit, but truly, it is not.  You will open your friend’s eyes to the future that awaits us all while also providing him with a lesson on how to enhance the life of someone whose world has been drastically reduced in size.

See?  It’s a win-win-win situation!  You receive the help you need, your parent gets a change of scenery, and your friend learns a valuable lesson.

I want to encourage you to check into local resources that provide suggestions on how to be the best caregiver you can be.  For example, your local chapter of the Alzheimer’s Association is a very valuable resource. They have numerous articles within their website and a 24-hour Helpline 1-800-272-3900 to ease you through this process.  There’s one thing on which all of us caregivers can agree – we can’t do it all by ourselves.  Reach out to receive the assistance that you so richly deserve, and that others are willing to provide.

Senior Health Specialists? Geriatricians? Where are you?

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The heading from an Associated Press story by Matt Sedensky, “Who’s going to take care of our aging population?” should wake ALL of us up; not just us Baby Boomers, but ALL of us because at this stage of our world’s existence, no one has created a magic elixir that cures old age and dying.

Talk to anybody who is in med school, or considering med school, ask them what specialty they would like to focus on and you’ll hear: orthopedics, pediatrics, heart disease, cancer treatment – all worthy fields but I would venture to guess that not one of whom you ask that question has said, Geriatrics or Senior Health.  “What about geriatrics?” I ask them.  “We’re living longer so you’ll ALWAYS have a job taking care of a civilization that’s fighting to stay alive as long as it can!”  They don’t buy it, especially since Geriatricians are  one of the lowest paid medical specialties amongst the medical community.

Square Dancing class at my town's Senior Center.

Ugh!  Who wants to deal with the wrinkly, saggy, hard-of-hearing, loud complaining geezers among us?  Not very many according to the linked article above.  According to Mr. Sedensky’s research, there is roughly one Geriatrician for every 2,600 people 75 and older.  No wonder people can’t find a doctor who specializes in Senior Health!  I facilitate an Alzheimer’s Caregiver support group in my town wherein these family members expound on their frustrating efforts to locate a doctor who: a) will spend the time needed to have a productive appointment with their aging parent; b) who knows enough about elder health issues to suggest a treatment that will provide quality of life for the patient; and c) who has a medical staff that is sufficiently trained to interact with their elderly patients.   Unfortunately, the General Practitioner or Internist quite frequently provide the same treatment, and the same method of communicating, to their elderly patients – even those with Alzheimer’s or other dementia –  as they do their patients in their 20’s thru 70’s.  That just won’t cut it.

Older patients have more complex conditions – and more of them.  If a medical professional isn’t accurately trained, he or she might discount an elderly patient’s symptoms as those expected during the normal aging process and therefore offer no effective treatment.  “What can you expect at your age Mrs. Jones?  Be glad that you’ve lived this long!”  I know – that sounds really callous – but I dare say too many elderly patients are treated dismissively, and as a result their quality of life decreases greatly.

My wonderful Dad, pre-Alzheimer's, on my wedding day.

Think about it my fellow Baby Boomers.  Are you willing to be dismissed just because your doctor doesn’t know what the heck he’s doing?  I know that all of us have been to doctors who we’ve “fired” because of their lack of understanding and/or their failure to provide proactive treatment.  The vulnerable adults among us might not realize that they have choices.   They might not feel confident enough to challenge the highly educated medical professional to whom they have entrusted their lives.  Who loses in that equation?  We all do.  If our aging relatives don’t have appropriate medical care options at this time in their lives, why do we think that there will suddenly be an influx of Geriatricians to treat us when we’re their age?

Maybe this is a lost cause for us but it doesn’t have to be that way for those coming up in the aging ranks behind us.  What are your thoughts about this glut of Senior Health professionals?  How can we hope to live in a world where quality of life – something we value greatly – is an unreachable, yet much desired goal?