mythsThere are many misconceptions out there about Alzheimer’s. Below are some of the most common, along with explanations about what the real deal is. There are cures that will stop the development of Alzheimer’s. Unfortunately, at this time there is no cure for Alzheimer’s disease, and no way to halt its progress. However, there are drugs that will, temporarily, pause the deterioration of or even improve cognitive skills and memory. But they only, for a period of time, treat the symptoms and not the disease itself. These drugs only work for some people, so there’s no guarantee that they can help your loved one. These drugs include cholinesterase inhibtors like Aricept and Exelon, and memantine (also known as Namenda). Cholinesterase inhibitors are used in the earlier stages of Alzheimer’s, and memantine is prescribed later on. The aspartame in artificial sweeteners contributes to memory loss. Aspartame is an artificial sweetener approved by the FDA in 1996. It is made by combining two proteins, phenylalanine and aspartic acid, with methanol, a chemical found in various plant foods. The studies that have been done on this issue so far have yielded no evidence of a connection between memory loss and aspartame. The use of aluminum in cooking or with food can cause Alzheimer’s. Current studies do not show that eliminating aluminum, such as that in pots and pans and soda cans, reduces one’s chances of getting Alzheimer’s disease. The jury is still out on aluminum’s relationship to the disease, but scientists generally think that it is unlikely that it has any significant effect. Alzheimer’s disease can be caused by a head injury. This one is partially true: researchers have proven that having a severe head injury with loss of consciousness during one’s life will increase the chances that the individual will get Alzheimer’s disease. However, researchers don’t yet understand why this occurs and what is happening in the brain during these incidents that leads to Alzheimer’s. Alzheimer’s disease won’t kill you. Alzheimer’s is, in fact, a fatal disease. It first destroys brain cells that assist with memory functions, but over time the damage will spread to parts of the brain that control essential bodily functions. It can be hard to attribute death to Alzheimer’s disease, however. Many Alzheimer’s patients, due to their age, are experiencing a number of health issues. It is likely that several different problems contribute to the actual cause of death.
senior day trip to the zooWe think of zoos as a classic class trip for children–but seniors can enjoy them too! Taking your loved one to visit a zoo, possibly with the extended family in tow, can be a great way to create togetherness and provide a stimulating activity for your loved one. In southern California we have some of the best zoos and aquariums in the nation, so this can make a great local day trip. Interaction with animals is beneficial both for seniors and their stressed caregivers. Research has shown that this activity contributes to lower blood pressure and makes people feel happier. The increased chance of social interaction that happens during a zoo visit, whether the senior is part of a group or just visiting with one caregiver, also has positive effects such as reducing the chance of depression. Your loved one will even get more exercise than they do when they stay at home. For various reasons, seniors are often not able to have pets. This can be a difficult restriction to live with for those who are lifelong animal lovers. But regular zoo visits allow these seniors to experience the benefits of animal interaction. Those who have Alzheimer’s disease or other forms of dementia can specifically benefit from zoo visits, as this environment can trigger happy childhood memories. Be sure to plan your trip carefully, as that will help the day go smoothly and minimize stress for both of you. Schedule your trip for a day when the weather will be good. You’ll want to arrive close to opening time, when the zoo will be less crowded. Discuss with your loved one what exhibits they want to see, and get a map of the zoo beforehand so that you can plan the best route for seeing everything on your list. That way you won’t get lost or waste time backtracking once you’re there. When you’re at the zoo, don’t be afraid to ask for help. The staff regularly deal with various people with disabilities and know ways to help your loved one get the most out of their visit. Zoos often offer priority seating during events for those with mobility or vision issues. Special audio assistance devices can also be arranged. And be aware that many zoos offer senior discounts or other special deals for the elderly. A trip to the zoo can be a fun diversion for both seniors and caregivers, breaking up the monotony of the day-to-day.
caregiving positive attitudeThrough our communication with others and with ourselves, we create reality. Does that sound a little new age to you? Think about it. Everyone has a friend whose negative attitude makes them difficult to be around because you in turn start to feel more pessimistic. Or, on the other end of the scale, there are enthusiastic people who leave us feeling more energized. It’s a basic fact that the people around us influence what we think and feel. And this is true not just for our friends and family, but for ourselves as well. What we think and say to ourselves can change our lives. Examine your own thoughts about caring for your loved one. If you say to yourself, “This is a hard situation” you’ll experience it as being unpleasant. Try telling yourself, “This situation is a challenge” instead. Can you see how that might change how you look at things a little? Challenge implies that this is something you can overcome, and that will make you stronger as you deal with it. Watch how you discuss the events in your life, both what you tell others and what you tell yourself. Our words not only describe our feelings, but also create what we feel. Here are a few other tips for keeping a positive attitude:
  • Express thanks at the end of each day. Take some time to look back over your day and think about the things that went right. Even if you had a truly lousy day, you probably still have a roof over your head, food to eat, friends and family members you love, and a life in one of the wealthiest countries in the world. You can always find something to be grateful for.
  • Commit a random act of kindness. This can be one of the best ways to make yourself feel better and adjust your mood. Try bringing your mother flowers, giving a neighbor a small present, or paying for the person behind you in the drive-through. We usually think that to feel good we need to do things for ourselves, but doing things for others can have a powerful impact.
  • Take a minute to appreciate nature. Even if it’s just a small park or your backyard garden, there’s probably some place close by where you can go for a few minutes to clear your head and be in the moment. You don’t need to hike out into the wilderness. Just take a few minutes to admire the beauty of the world around you. Consider it a mini-vacation.
All of the above isn’t to say that you should never complain – to keep your frustrations bottled up inside clearly isn’t healthy. But be careful not to get carried away when you do indulge in venting. You may want to set a time limit for airing your greivances, and then when you’re done make a point of reminding yourself of the big picture. Caring for your loved one can be aggravating, but you are doing your best to make sure that they’re healthy and comfortable. Revisit your reasons for taking on these responsibilities in the first place. In this way you can connect to the deeper meaning of caring for someone you love, which is a deeper happiness that goes beyond day-to-day annoyances.
reducing medical billsHealth care bills are notoriously confusing. Of course, Medicare all by itself is a maze, but beyond that there’s also the out-of-pocket expenses that Medicare doesn’t cover. These can be a significant financial obligation: almost $200,000 for a married couple over the course of their retirement according to one estimate. Here are some steps you can take to try to make these expenses more manageable. 1. Use in-network providers Whenever possible, use in-network providers for all your care. This can lower your bill tremendously, as in-network providers have previously negotiated what they’ll charge with your insurance company. Take the time to sit down with your plan to understand what is covered and what isn’t. This can result in significant savings, both immediately for particular medical events and over time. 2. Examine your bill closely Whenever we get a bill, many of us will quickly write a check out of habit, wanting to be prompt and on top of these sort of things. However, it’s worth taking the time to go over medical bills line-by-line, as they frequently contain errors and services that you or your loved one didn’t receive (as often as 80% of the time!). This is the time to be a pain and question anything you don’t understand: don’t pay until you’re confident about what you’re paying for. You’ll also want to verify the basics, such as your name, address and date of service. You may be surprised at how often it’s worth it and that being thorough leads to savings. Plus, it’s a much better idea to do this up front. If you discover an error later, it may be very difficult to get a refund from the provider after you’ve paid. Unfortunately, they’ll tend to be more responsive when they’re eager to get the matter resolved and have your payment in hand. 3. Verify that the bill has been adjusted for insurance payment One important item to note when reviewing your bill is whether the different line items have been adjusted to reflect the insurance rates. If you don’t see this, insurance was not applied. You should contact the office right away to make sure they run the charges through your insurance first. 4. Check the bill against your EOB You should never pay a medical bill without getting an EOB from your insurance company first. This document will verify what you’re supposed to pay. This is an important step for eliminating possible errors. Be wary if the bill arrives much sooner than the EOB does–this means that the medical provider has not received payment from your insurance company yet. 5. Be proactive Don’t just let errors slide–contact both your insurance company and the provider to resolve billing issues. Often it will be important to be persistent: sadly, larger companies will try to win in these disputes by ignoring you sometimes. At the same time, make sure you keep the lines of communication open with all parties. If you are waiting to hear from your insurance company before you pay the doctor, let their office know what the delay is. Otherwise, they may be very quick to assume that you’re trying to dodge the bill and send the account to collections. This will be counterproductive, resulting in more unnecessary charges and time spent resolving the issue. 6. Negotiate Even if you don’t have insurance, you can try asking providers if they’ll charge you the same rate they charge insurance companies. Also, if a bill is more than you can afford right away, see if the provider will lower it in exchange for faster payment. You can also try asking for financial assistance. Some providers will let you pay in interest-free installments or work out some other reasonable arrangement. They would much rather get the bill paid than have you feel the situation is hopeless and ignore it.
dementia and illnessDementia can make it difficult to tell when a loved one has come down with a cold or another illness. They may not be able to tell you how they’re feeling in an intelligible way. By being observant and keeping an eye out for certain signs, you can spot when they may need a little extra TLC, medication, or a trip to the doctor. Here are some tips.
  • A runny nose or sneezing by itself may not be a cold or flu–it might be just allergies instead. Try to determine if your loved one has additional symptoms, like fever or tiredness. If they do have a cold, make sure that they stay well-hydrated.
  • Those with dementia or Alzheimer’s are unfortunately susceptible to urinary tract infections. Due to the intimate nature of the task, keeping these areas clean isn’t always easy for caregivers. If their urine has a strong sour smell, they likely have an infection and need treatment. Urine may also be darker or even contain blood, and your loved one will have to use the bathroom more frequently than usual. Finally, urinary tract infections can cause behavior changes in seniors and even bring on dementia symptoms. If you notice any of these signs, be sure to treat the infection right away. A neglected urinary tract infection can land a senior in the hospital.
  • Look for signs that your loved one is paying attention to or favoring one part of the body over others. That could indicate that they’re experiencing pain. Do a thorough check of the area to see if there are any bruises or other abnormalities.
  • Watch for changes in bowel movements and abnormal stool. If problems don’t respond to over-the-counter medication, seek the advice of your loved one’s doctor.
  • Changes in speaking patterns or behavior is another important sign. If a loved one’s demenaor suddenly changes without obvious explanation, and attempts to distract or calm them down don’t work, illness or injury is often the cause. They may also attempt to “speak” to you using gibberish. Even though your loved one cannot express themselves properly, they’re trying to give you information.
Your best tool as your loved one’s primary caregiver is intimate knowledge of their usual habits and behavior. Once you notice variations from what’s typical, you should begin to suspect that problems are afoot. If you have any concerns about your loved one’s health, be sure to get in touch with their physician.
depression and dementiaDementia and depression share many common symptoms: withdrawal from loved ones, decreased interest in activities that were once enjoyable, memory difficulties, and an increase in sleep. Researchers have begun to explore the connection between the two and to ask whether dementia causes depression, or if perhaps depression causes dementia? One study has found that those who have had a incident of depression are three times as likely to develop dementia. Other studies discovered that when in their life a person experiences depression can influence what kind of dementia they get. Those whose depression begins in mid-life are more likely to get vascular dementia. However, if the episode of depression occurs late in life, Alzheimer’s disease is more likely. Researchers aren’t sure what causes these links, but they do have some theories. One is that when an individual is experiencing depression, their body produces a greater amount of the stress hormone corisol. This hormone has been shown to do damage to the areas of the brain that manage learning and short-term memory. Depression can also cause inflammation which can harm blood vessels. Finally, there’s also the possibility that the hippocampus, which helps the brain process information and create memories, is harmed when the brain experiences stress long-term. Some even speculate that since depression causes people to be less active both physically and socially, that less challenging lifestyle may accelerate the decay of the mind. Researchers are very careful to state though that they still have much to learn about this area of study. The connection also seems to work in reverse, with dementia patients being more likely to become depressed after the disease has taken hold. Also, the similarities of the two conditions and the fact that they share many differences make the connection between them difficult to tease out. One implication that is relatively clear, however: depression needs to be taken seriously and treated as soon as it’s caught. Left alone, it can cause too much damage to an individual’s brain, even if that person eventually moves past depression without intervention. Seniors and their caregivers should know that depression is not a normal sign of aging: it is a mental health issue that needs to be addressed no matter the age of the patient. This is certainly an area of research to watch over the coming years, and holds promise for helping us understand how conditions of the mind and spirit can ultimately affect the body.
seniors who want to go homeThere are many seniors who make the transition to assisted living or memory care comfortably. But unfortunately, due to the nature of the disease, sometimes loved ones are faced with an uncomfortable request: “I want to go home.” Such a plea is heartbreaking, and when you hear it every time you visit it can leave you quite distressed. The first thing to know is that when your loved one says “home,” they probably don’t mean their previous residence. Remember that due to Alzheimer’s and dementia, they’re living in their earlier years. Home is most likely their childhood home, and that place and the people they lived with may be long gone. So before you beat yourself up with guilt, know that they are requesting something impossible that you couldn’t give them no matter how hard you tried. The best way to deal with this request is with gentleness and a little bit of subterfuge. This is one of those moments where enabling your loved one’s denial may be the better course. Avoid correcting or arguing with your loved one, as this will only cause distress without really aiding them in recognizing the truth. First, use positive body language such as nodding your head. Then try to change the subject. Look for something interesting going on in the immediate environment. Maybe there’s a bird outside the window, or a colorful painting nearby. Point this out to them and shift the conversation. It may also be helpful if you can move them physically: guide them to the object of interest or turn them to face a different direction. You are trying to get them out of an unproductive rut. From there, seguey into your loved one’s memories. Get them to talk about what “home” was. This will help them pay this cherished place a visit, if only in their minds. A photo album might be helpful here if you have one. Your discussion may give you some clues about how you can bring home to them in their new living space. Perhaps there are beloved objects or furniture that will help their new surroundings feel more familiar. Your loved one will likely not completely stop talking about home, and you’ll likely continue to feel the pangs of heartbreak. However, some knowledge about where the request is coming from can help you accept it. This is a case where you may not be able to change external circumstances, but you can change how you react to them.
advice for new caregiversTaking charge of mom or dad’s affairs and becoming the one responsible for their well-being may have happened suddenly with a crisis event, or it may have snuck up on you over time. However you ended up here, you likely feel like you need some advice. Here are some things to keep in mind as you navigate this new world. Set Good Boundaries Setting good boundaries can be difficult when it comes to the loved ones who are closest to us, like our parents. They sacrificed so much for us, right? However, if you drop everything for mom and dad it will cause much larger problems, and you’ll be so burned out you won’t be able to be there for them. If mom is calling you from assisted living mulitple times throughout the workday, you need to be clear that this is preventing you from fulfilling your obligations to your employer or clients. This may seem harsh, but if you career begins to suffer you won’t be as effective when it comes to caring for her. Understand that Needs Change If you’ve been thrust into your new role by a stroke, accident, or other crisis event, there will be a time when life begins to settle into a routine again. But don’t get too set in your ways: there may be another crisis that’s somewhere around the bend. It’s simply part of the unpredictability of life, and you will need to adapt if you’re going to keep up with your parent’s needs. What worked before may not work now. Don’t be afraid to ask for help or to look into adding new care. Reach Out to Others in Your Situation You’ll get a great deal of support from those whose loved ones have more advanced Alzheimer’s or dementia. You can find a caregiver support group somewhere near you, or you can seek out others online. This may in fact be better since you and other caregivers probably don’t have much time for face-to-face meetings. Try the Alzheimer’s Association or your local hospital for recommendations. Notice that a lot of this advice has to do with taking care of yourself, your physical well-being, and your own mental state. The old cliche of helping yourself before you can help others has never been more applicable than when it comes to caregiving. Your loved one is counting on your health for their own wellbeing.
convince parent to move to memory careMaking the decision to enter memory care is difficult for seniors, and it’s a process to get them to accept that this is the right choice. They of course want to remain on their own as long as possible. A big decision like this can’t be forced. Your best chances of success lie in helping your parent own the decision, so that they have the feeling that this is something they’re choosing for themselves. Here’s a step-by-step plan for how to get your parent to accept a move to memory care. 1. Help mom or dad begin to get used to the idea. Identify problems that would be solved by a move to memory care and how that move would improve quality of life. For example: “You know, mom, you wouldn’t have to worry about hiring someone to take care of the lawn if you were in memory care.” Or, “Dad, wouldn’t it be nice if you lived somewhere with people your own age around?” 2. Offer to help them tour some nearby memory care facilities on a no-strings-attached basis. Try to seek out activity times when they can notice the residents having fun. However, it may still be too soon for them. Be prepared to just drop it if they show resistance to the idea. 3. Help them see the signs that it’s the right time for this sort of care by connecting this need to things that happen. For example, when mom leaves the stove on, gently but tactfully use the opportunity to point out that both of you would be less worried about these incidents if she were in memory care. Be careful not to be too pushy here, unless there really is a crisis brewing that would necessitate moving quickly. 4. See if anyone your parent knows has made a move to memory care, assisted living, or a similar facility who is happy with their choice. Or see if the relatives of any of your own friends are enjoying senior living. Take your parent to visit that person, or at least set up a phone call. This will help make the idea more real to them, and may make moving to the same facility more appealing. Even having one friend in a new place can help. 5. When you go on tours, point out all the positive aspects of the facility. Be as excited as you would be about renting a new apartment or buying a new home: focus on the possibilities. Would mom’s favorite antique chair look good in the rooms of a particular facility? Does the activity room have a piano so that dad could still play? Once you’ve gone through this process, wait for all that you have seen and discussed to sink in. Don’t expect that they’ll have that “Aha!” moment right away: unfortunately, it often takes some sort of accident or crisis for a move to seem necessary. They are making a huge life decision, and that needs to be respected. If you are feeling the need to move your parent along in this process, however, the most effective argument would be to say that you and other family members would have much greater peace of mind if they were in a memory care facility. Remind them how much their safety means to you. This will hopefully help them to see the importance of making the move.
early alzheimers medical challengesOne hardship for those with Alzheimer’s is a lack of understanding about this disease from those in the general public. Though it may hurt sometimes, to some extent this is understandable. We can’t all be expected to be knowledgeable about every disease, even more common ones. Typically, we forgive those who are important to us if they need a little education. But many Alzheimer’s sufferers and their caregivers are surprised to discover that many in the medical field, who do not work with memory care patients frequently, also do not have a good understanding of what Alzheimer’s is. Imagine someone in the early stages of Alzheimer’s falls and breaks their hip, requiring a stay in the hospital. When the doctor interviews her and her son to learn about other medical conditions that may affect treatment, they mention that she has early Alzheimer’s. The doctor seems to ignore this information, which he fails to see as relating to the broken hip, especially since after a casual interaction he notices no cognitive impairment. However, our patient quickly runs into problems. The doctor goes over instructions for her pain medication at a time when her son isn’t at the hospital, expecting that she will manage this on her own. The next time her son comes in, he finds her in extreme pain because she hasn’t taken the medicine on schedule. He points out this problem to the doctor. The hospital staff then goes to the other extreme, hovering over the patient excessively, speaking to her in slow loud voices, and even spoon-feeding her! Those with early Alzheimer’s know that this clearly is not the appropriate response either. Unfortunately, the fact is that medical professionals just don’t receive adequate training on how to handle those with more mild cognitive impairments. They are able to address severe impairments, but the shades of gray in between just aren’t discussed. However, that’s cold comfort to early Alzheimer’s patients and their caregivers, who feel ignored and misunderstood by the system. There’s no real answer to this problem for individual patients and families, since the issue is entrenched in our larger health care system. Hopefully in the future, all doctors, nurses, social workers, aides, and others will receive more refined training on how to deal with those with early Alzheimer’s and similar cognitive conditions. In the meantime, caregivers and patients should not assume that doctors and others will understand what they mean when they disclose early Alzheimer’s. Be specific about the kinds of communication you expect about the person’s treatment and how Alheimer’s will affect it.