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Understanding Parkinson’s Disease

Parkinson's disease becomes more severe over time.Parkinson’s disease is something that develops slowly over time. In the beginning, symptoms may be mild, but will eventually become more severe. This is due to the gradual decrease of the neurotransmitter dopamine. Nerve cells that use dopamine to send messages to control muscles can no longer do so if the brain cannot supply them with sufficient amounts of the chemical messenger. Recognizing Parkinson’s The common conception of a person with Parkinson’s is that they suffer from uncontrollable tremors and muscle movements, but this doesn’t occur in the early onset of the disease, nor is it universal in all sufferers. Researchers have isolated four pre-motor symptoms:
  1. Body movements occurring during REM sleep when only the eyes should be moving
  2. History of constipation
  3. History of depression and anxiety
  4. Diminished sense of smell
Since early treatment can keep the disease under control, it is vital that you be aware of the above warning signs in loved ones as well as:
  • Changes in speech patterns such as slurring, hesitation, low volume, a monotonous voice, and difficulty in choosing words
  • Increased sweating or urination
  • Changes in personality
  • Low blood pressure when standing
  • Foot cramps
  • Drooling
As the disease continues to progress, the following areas may be affected:
  • The face: this manifests itself as “Parkinson’s Mask,” or the loss of ability to smile, blink, or alter facial expressions
  • Fine motor skills: handwriting may be unusually small
  • Muscle coordination: there may be difficulty with walking, rising from a seated position, and swallowing
  • Cognition: watch for memory problems, the degeneration of problem-solving skills, attention deficit, confusion, and the inability to make decisions,
  • Mental health: the person may experience depression, hallucinations, or signs of dementia
Diagnosis The importance of early diagnosis and treatment cannot be overstated since Parkinson’s often makes an insidious entry into a victim’s life, establishing itself before he or she realizes something is wrong. So if you notice even one of the above symptoms in a loved one, pursue immediate medical evaluation. There is no definitive diagnostic tool for Parkinson’s. Blood testing rarely uncovers abnormalities, nor do MRIs, EEGs, and CAT Scans spot any brain change. Therefore a doctor must make a clinical diagnosis (one based on his or her own judgment). It is crucial you seek a neurologist with a thorough knowledge of Parkinson’s disease to evaluate your loved one. Evaluation After taking a family history and performing a physical examination, the doctor will ask you and the patient about observed symptoms, then watch him or her stand up, turn around, walk around the room, etc… all in an effort to judge movement, balance, and coordination. Treatment The Doctor will prescribe drugs to alleviate symptoms, the most common of which is Sinemet (Levodopa/Carbodopa).
  • Levodopa, also known as L-Dopa, travels to the nerve cells of the brain that should be producing dopamine, where it is converted to dopamine for use as a neurotransmitter.
  • Carbidopa increases Levodopa’s effectiveness and decreases possible side effects like nausea, vomiting, and occasional heartbeat disturbances.
If medications have minimal effects, or cease to be effective, depending on age and overall physical condition you may want to pursue alternate treatments as Deep Brain Stimulation or Stem Cell Treatment. Care A Parkinson’s patient needs individual care and constant observation. In a perfect world he or she could remain in their own home, but this is often not possible. An excellent alternative is a board and care home, like Raya’s Paradise, where staff keep a watchful eye and make sure medication is taken. There is no cure for Parkinson’s, but we can buy time and make that time as pleasant as possible.
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How to Address the Effects of Vision Loss

Vision loss is more than simply loss of sight.The loss of your loved one’s vision is a loss of their independence and a battle with their quality of life. The decline in their depth, central, and peripheral perception has a negative effect on mobility, communication skills, safety, and emotional health. It’s very important to come up with a plan to help them cope. Impact of Vision Loss The easiest way to think of how your loved one feels is to think of someone who is hearing impaired. They communicate by sight, with their hands, and read lips. They are able to pick up facial expressions, head nods, and gestures. You may already have to speak louder to a loved one because of hearing loss. The loss of two senses is heartbreaking and leads to a lack of social interest and activity, a poor quality of life, anxiety, and even depression. There are also safety issues associated with vision loss. Your loved one is in danger of falling doing normal activities, slipping on spilled oils, lotions, or food. They could trip over cords that were previously tucked away, or miss stepping over something because of poor judgment of the height of an object. Loss of vision impairs driving ability and increases the chances of vehicle accidents. The worst safety concern is that your loved one might not be able to effectively communicate what is wrong because they’re in a state of panic and not able to see their surroundings properly. Living in assisted living can mitigate some of these risks because the environment is designed for senior safety, but it’s impossible to completely prevent accidents from happening, especially if a senior miscalculates what they can handle. Helping Your Loved Ones Cope With Vision Loss There are many things you can do to help your loved one cope with vision loss.
  • Color code medicine bottles or purchase pill containers to help with medication management
  • Make standardized arrangements of household items
  • Add safety features to household items such as table edge guards and gates around stairs, and place non–slip mats around slippery areas such as the kitchen
  • Decrease glare from the sun or other light sources in the home; add motion sensors and plenty of lighting
  • Minimize clutter and bulky furniture
  • Attend eye doctor appointments with your loved one; discuss all medication because drug reactions can have side effects on vision as well
Your loved one may feel they are a burden and keep important issues away from you. It’s important to let them know you are there for them. Set up a caregiver treatment plan. Help them connect with community resources for assistance such as transportation services and support groups. Provide self-help aids such as magnification devices, various eyewear, tinted lenses, closed-circuit television, large print books and telephones with dials. If they enjoy sewing, have a needle threader and plenty of thimbles. If they love novels, get them a subscription to an audio book of the month club. By being mindful of what loss of vision means and showing compassion and support, you can ease the negative effects of this health condition.  
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Notice the Seniors Around You

Noticing the seniors around you can bring rewards.When you visit your loved one, do you ever take a look at any other residents? I mean really take a look. Or have these elders become part of the background of the facility? How about that tiny woman with the thick glasses who’s always in the main lounge, shading her eyes from the light; or the frail man with the gray hair who nods at you from his wheelchair whenever you pass by? And that Asian man who likes to sit by the window watching the traffic outside, have you ever wondered about him? Your mom or dad’s new neighbors all have a piece of history attached to them. Some struggled in school, while others triumphed. Some worked with numbers while some pursued their creative abilities. Some individuals worked at exciting or prestigious jobs, others at boring repetitious ones. They lived, loved, and laughed, just like your mother or father. Why not take the time to learn a bit about them, too? When you’re spending time in the lounge with your mom or dad, choose a seat within speaking distance of another resident. Start with a smile. You never know where a casual comment may lead. We all crave conversation. In most cases, it doesn’t diminish with age. In sharing their stories, a senior has a chance to relive their experiences here and now, rather than in the recesses of their memory. They matter to someone who wants to know who they are. As for your mom or dad, perhaps they will gain a new friend out of your simple outreach. Maybe your dad was a pharmaceutical salesman, too. Maybe your mom was an I Love Lucy fan, too. Common experiences can serve as a firm foundation for a friendship. You’ll feel better knowing she’ll have someone to “hang out with.” You might benefit in other ways too. Widening your circle of older acquaintances might result in practical advice you can put in place in your own life. And when you least expect it! Take that lady mentioned above, the one with the glasses. A woman visiting her father, who was a writer experiencing a string of rejections, struck up what she thought was a casual conversation with the unassuming senior. As she wheeled her father toward the elevator, she offered her arm to the old lady hobbling beside her. She learned that the woman had been an accomplished illustrator of children’s books in the 1960s and ‘70s. “Oh, I tried writing children’s books,” our visitor replied. “And what happened?” asked the woman. “I gave up.” “Well, you must start again,” was the advice offered. And so she did. So, look around. At the very least you’ll break up the monotony of another human’s life. You never know, you might hear about a life of accomplishment. That Asian gentleman by the window, he was the youngest in a family that emigrated from China. Inspired by parents who believed in education and excellence, he went on to medical school and opened his own neighborhood practice, holding off retirement until the age of 82. And the friendly gentleman in the wheelchair — after a career as a cameraman in Hollywood studios, he opened a successful store specializing in nuts and fine candies. It flourished for years. Notice someone, because you never know where it will lead.  
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Caregiving and Anxiety

These three tips can help ease caregivers' anxiety.We probably don’t have to tell you that those with elderly parents are more prone to anxiety. The root of anxiety is unexpected changes, and the health of seniors can change suddenly. Caregivers are also working hard to balance multiple priorities, and often feel stretched to the max. Addressing severe anxiety will require help from a doctor or therapist, but the tips below will give you some tools that you can use on your own to get to a more relaxed, peaceful state. 1. Do something you enjoy. Yes, we know you don’t have a lot of spare time. But there’s much you can do to make life more pleasant in the bits of time you do have. A ten minute walk on a nice day can work wonders, especially if you make a point of being in the moment and enjoying it. Another thing to do that adds virtually no extra time is to listen to your favorite music while you’re in the car, at your desk, or doing chores. Also, try to squeeze in time for your hobbies. Even spending just an hour a week, or one day a month, can help lift your mood and give you an outlet. 2. Try meditation or breathing exercises. Simply taking a few minutes to focus on your breathing has more of an effect than you might think. If you find your anxiety rising, stop and take some slow, deliberate, deep breaths. This basic technique should help, but you can search online for more breathing exercises to get further benefits. Meditation or prayer can have similar advantages. Don’t worry if you think you don’t know how: meditation can be as simple as taking the time to pay attention to your breath and the present moment. You don’t have to be an expert. 3. Focus on nutrition and exercise. When we’re busy, taking care of ourselves can be one of the first things to go. But sticking to healthy routines goes a long way to staying on track in life. If you find that in your stress it’s hard to say no to fatty or sugary comfort foods, start not by cutting back on the things you crave but by adding healthier options into the mix. Have a piece of fruit as a snack or a salad along with your dinner. You’ll likely find yourself wanting less as these additions help curb your hunger, and as you develop a taste for healthy choices you’ll pick them more often. As for exercise, even a walk and a quick stretching routine can make a difference. Addressing your anxiety is not just about helping you feel more calm and peaceful, but about helping your loved one as well. Your parent is probably picking up on your stress, even if you think you’re hiding it, and they themselves feel more stressed in turn. Taking a little time for yourself to follow these steps will benefit not just you, but everyone around you. For additional tips, check out our post on caregiver stress.
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Forgiving Your Elderly Parent

Even if your parent has hurt you badly, you can forgive.Every parent-child relationship has at least a little hurt that’s developed over the years, and many of us hold resentment and anger towards our parents for past wrongs. Some have unfortunately had to deal with a parent’s addiction, neglect, or abuse. When the time comes when your parent needs more day to day help and assistance with managing their affairs, these emotions can prevent you from stepping in to help. How can you manage this situation when your emotions make it difficult to meet your parent’s needs? If you are willing to forgive but are unsure how, take hope: healing the rift is possible. First, stay focused on the present. The past is over and nothing can be done to change it now; you have nothing but pain to gain if you hang onto it. Remember that by clinging to your resentment, you are only making yourself feel bad. There are even studies that show that people who are able to forgive lead longer and healthier lives. Recognize that the wrong you were done has helped make you who you are today, and may have caused you to develop some of your strengths. For example, struggling with an abusive parent may have resulted in you becoming stronger and better able to stand up for yourself and protect your boundaries. It may also mean that you are kinder and more able to keep yourself from lashing out in ways that are harmful to others. Consider looking at your history with your parent from a different angle. Were they doing the best they could do at the time? Were they struggling with circumstances beyond their control? Put yourself in your parent’s shoes, and while you shouldn’t excuse bad behavior, you may find yourself more able to understand how it could happen. Finally, seek out stories about those who have forgiven people who hurt them. Hearing the experiences of others can help inspire you or give you a guide for how you yourself might forgive. There are many story collections out there on this topic – your local library is sure to have at least a few. You can also look for movies that address the theme of forgiveness. Remember, forgiving someone doesn’t mean that the wrong they did is now OK. But try to separate the person from their behavior. We all make mistakes and behave badly at times, but that doesn’t mean that at our core we don’t deserve love and a second chance.
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How Often Should You Visit Your Parent in Assisted Living?

How often should you visit your parent in assisted living?When a parent first enters assisted living, their children often feel wracked with guilt. Does your loved one feel abandoned to a strange place? Could you have made in-home care or another arrangement that would allow them to live with family work? First, think about yourself. This may seem like the wrong advice right now – my parent needs me! – but we’ve all heard that we need to take care of ourselves before we can take can of anyone else. You most likely have other obligations that you cannot let go: work commitments, caring for children, maintaining a good relationship with your spouse. Your parent is important, but so are these other parts of your life. You need to make sure that the time you spend with your parent doesn’t result in neglecting other vital relationships and needs. Second, think hard about what your parent really wants. Some seniors get comfortable in their new home, sometimes sooner rather than later, and are so busy enjoying new friends and what the facility has to offer that they don’t need or want you to visit everyday. Have a conversation with your parent about visiting if you think they still have the mental capacity for a productive discussion, or observe them carefully to get a sense of how much they really want you there. Even if they’re not social butterflies and seem to spend a lot of time in their room, they may prefer the alone time, and it’s possible that too frequent visits may make them feel less independent. Especially when a senior is experiencing cognitive decline, you may need to separate what they say from what they really want and need. If mom calls to ask why you never visit her three hours after you were there, it’s likely that this has nothing to do with how dutiful a child you are. She may have simply forgotten how often you’ve been coming to see her! Be careful about taking her remarks personally. A final consideration in deciding how often to visit is how you will feel about your efforts as a caregiver after your parent has passed away. If, after considering what’s possible and the other things in your life, you think you will be comfortable with how much time you spent with your parent, you have probably found a good balance. However, if you think you may have regrets, increase your visiting schedule now while you still can.
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Choosing Assisted Living for Senior Couples

There are options for senior couples moving to assisted living.For aging adults, the move to an assisted living facility is a major life change, but even more so for a couple who has lived together for many years. It is comforting for families to know that while the selection process is still challenging in this situation, there are a growing number of facilities offering accommodations for couples. For a couple whose health needs are very different (i.e., one is in excellent health and the other is experiencing cognitive decline), you as the caregiver may be able to find a facility well able to accommodate the needs of both individuals. However, because their needs are vastly different, some facilities may house one in a particular area suitable for them, and then do the same for the spouse. In situations like this, while the couple does not live in the same room, they are still able to visit with one another often and share meals and other activities. This is often quite beneficial for the spouse in better health, because while their spouse’s health needs are too great for them to handle, they can still live and socialize under the same roof. When both spouses are experiencing similar levels of health challenges, arranging for common living space is much easier. For these couples, privacy may become a major hurdle and developing social relationships with others in the assisted living facility can become more difficult (as it becomes much easier to simply keep to themselves). The rule of thumb, though, for the caregiver and assisted living staff, is to focus your selection options on the spouse whose health needs are greater (or the spouse who is older). Discuss this with your loved one’s healthcare professionals before coming to a final decision. Living together in an assisted living facility can come with tremendous cost benefits as well. Generally speaking, in situations where one spouse is very healthy and the other requires higher level care, the spouse with good health simply pays for room and boarding expenses, while an additional fee is assessed for the care of the other spouse. In short, they are paying for only one room. Many assisted living facilities offer a pricing tier, with the lowest care needs at the bottom of the tier, while others provide services using a la carte, fee-for-service or all-inclusive pricing packages. The truth is, cohabitation with a loving spouse or partner translates into increased happiness and overall better health generally. These benefits would most certainly apply if the couple moves together into an assisted living facility. It may, in fact, strengthen the bond each has with the other, because in this type of environment, each individual’s needs are met in a friendly, healthy manner. Therefore, this gives the couple the freedom to reconnect with one another in a manner often lost over the years in the midst of health problems and other concerns. By consulting the staff, touring the facility and discussing your loved one’s health needs, you as a caregiver will certainly be capable of supporting your loved ones’ housing choices…together.
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Where to Start with Power of Attorney

Part of planning for a senior's future includes making power of attorney arrangements.Please note that this website is not able to provide legal advice. The article below is for informational purposes only and designed to help you get started on researching this issue further. We strongly recommend that you speak with a lawyer or other legal authority to understand how the law applies to your specific situation. When planning for your aging loved one’s future, one of the most important conversations to have is about granting power of attorney (POA). Someone who has power of attorney for an individual is legally able to make important decisions for them. To hold power of attorney both you and the individual must be 18 or older and of sound mind. Here are the basic steps for acquiring this important legal document. Discuss with Your Loved One the Type of POA You Want to Have. In California, there are four different versions of power of attorney, and each has a different function. Durable power of attorney will give you the power to make financial decisions for your loved one. Limited power of attorney will give you the right to carry out a specific duty, and once you fulfill that duty your power will end. Medical power of attorney allows you to make medical decisions for your loved one. General power of attorney is similar to Durable, but your power ends if your loved one becomes incapacitated. Decide Who Will Hold Power of Attorney. Your loved one may have several relatives and trusted friends who they might choose to act on their behalf. Choose someone who will be available to complete the specified duties and who has the most expertise depending on the type of power of attorney desired. A family member who is an accountant, for example, would likely make a great choice for holding durable power of attorney, but may not be the best person for making medical decisions. Your loved one’s comfort with that particular person is an important consideration as well. Complete the Paperwork. In California, Power of Attorney can only be granted in writing. Your loved one can create the document themselves, or someone else (often a lawyer) can create it for them. The document must contain the signatures of the person granting the POA and the person receiving the POA, what powers are being granted, and what date the POA will take effect (if not intended to start immediately, in which case no date is needed). Get the Document Notarized. The POA document will need to be notarized in order to be valid. Any bank branch can provide this service for you. Once these steps have been completed, make sure the form is somewhere where it can be easily accessed when it will be needed. The advantages of preparing in advance will be lost if the document is not available when important financial steps or medical actions need to be taken!
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When Should Your Parent Stop Driving?

steering wheelMany children of aging parents face a challenging decision: is it time to demand that your parent no longer get behind the wheel, or are you being overly cautious and wrongly limiting their mobility? The is one of the most crucial moments you’ll experience as a caregiver: it may be the first time you have to step in and request that your parent make a major life change for their safety (and that of others). While there is no pre-defined age threshold that signifies it’s time to hand over the car keys, there are warning signs that may prompt you to initiate the often difficult but necessary discussion about other transportation options for your aging parent:
  • Challenges with Vision: If your aging parent has been diagnosed with conditions such as macular degeneration, diabetic retinopathy or glaucoma, you will understand right away that your loved one’s vision is severely impaired. However, in cases where there is no diagnosis, but you observe such challenges as difficulty in maintaining their lane or in responding to road signs or traffic lights, this may indicate a decline in vision.
  • Memory Challenges: Because the memory decline associated with dementia or Alzheimer’s disease is often misunderstood, it’s important to understand that these diseases cause those affected to lose orientation and become confused at a moment’s notice. If your loved one has not been formally diagnosed but you notice such challenges as getting lost in familiar places, becoming very confused or being easily distracted behind the wheel, be sure to set an appointment to discuss these concerns.
  • Dents and Scrapes: If you begin to notice a number of scratches, scrapes and dents on the vehicle, fence, garage or several close calls, your loved one may be a danger to themselves or others while driving.
  • Physical Decline: Pain or stiffness in the back, neck, arm or leg areas can create real problems while driving. After all, drivers must still look over the shoulder or use the rearview mirror while behind the wheel, so a lack of dexterity can be especially detrimental while attempting to drive.
  • Side Effects of Medication: While medications are prescribed by doctors to effectively treat certain illnesses, these medications can produce side effects within the individuals taking them. Often, the list of known possible side effects is addressed briefly at the time the medication is being prescribed. However, if your loved one takes a number of medications, there is also a risk that certain medications taken together may produce an undesirable response within the body. Your loved one’s pharmacist can often research this information for you. Some side effects impair an individual’s ability to drive, so pay attention to this and respond appropriately if your loved one seems to be having trouble.
While an active and independent senior adult may find the change especially difficult, feeling that increasingly more aspects of their lives are outside their control, there are other viable options you can offer to help your loved one maintain a sense of independence:
  • Community or Senior Transit Systems: Your local area Agency on Aging can usually coordinate trips for senior transit to places like the doctor’s office or grocery store. Certain places of worship also have a system for transporting individuals who cannot drive themselves to different places within the community. Some medical facilities have also expanded their service offerings to include transport to and from appointments for patients unable to drive themselves.
  • Public Transportation: Depending on where you live, the public transit system may be  developed enough for your loved one to get around to different areas. Lower fares are usually offered for senior adults.
  • Create a Ride Sharing Program with Neighbors: This is a great way to increase the sense of community, build up social relationships and barter with others in your network. For example, your loved one may not be capable of driving, but might be able to help with other domestic tasks. Plus, the camaraderie formed is tremendous for older adults.
  • Get Around the Good Old Fashioned Way: Walking or cycling is a great form of exercise and helps reduce the risk of certain diseases. It’s an excellent way to get around on a warm, sunny day. Just remember that while some seniors can still walk or bike when they shouldn’t drive, there are safety considerations even for these simpler forms of transportation too.
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Helping a Child Better Understand Dementia and Alzheimer’s Disease

Children can have a tough time understanding the challenges of dementia.While it is incredibly difficult for adults to adjust to the progressive challenges that come along with caring for a loved one with dementia, the pain and frustration a child (or teen) might feel can become almost overwhelming. Imagine, for a moment, the difficulties in comprehending why their grandparent or other loved one no longer recognizes them or behaves in a manner inconsistent with previous experiences. It can be tough, but being aware of your child’s feelings and helping them learn to cope can reduce frustration on the part of both your child and your loved one. Dealing with dementia can be frightening as you watch your loved one’s memory and behavior fade into unknown territory. However, children are often curious and as they begin to notice changes, you might help to ward off anxiety by both anticipating questions and by quickly addressing their questions in an age-appropriate manner. For example, depending on the emotional closeness the child has enjoyed with the loved one, the fact that grandma can no longer remember them or seems to be acting bizarre in your child’s presence may suggest the loving, special bond once shared is now lost. Feelings of rejection can ensue. However, you can always do your best to reassure your child that the disease causes difficulty in remembering things. Remind them that Grandma does, however, still love them and regards them as a special part of her life. Young children may develop a concern that you, too, may begin to develop similar symptoms and that they might “lose” you, too. Educate them; dementia is not a contagious disease and it is not a part of the normal aging process. Questions regarding what happens next will have to be addressed gingerly. Young children thrive upon routine; therefore, you will do well to explain to young children how their normal routine may change a bit in the face of the illness. Combat feelings of jealousy by assuring them that although your loved one will need time and attention, they are still an important part of your family unit. Signs that dementia and Alzheimer’s disease is affecting your child may come in indirect manners, such as substandard grades or withdrawal from friends. In instances where your loved one is being cared for in the home, emotional expressions may become more exaggerated or more frequent. For example, your child or teen may become exceptionally frustrated at having to repeat themselves again and again, or from being subjected to seemingly silly accounts given by your loved one. He or she may feel that the loved one with cognitive decline gets all the attention and may lash out in the moment. While it is likely that both you and your child will be learning – and coping – with the effects of the disease at the same time, gently remind them that all people (even those who are forgetful and sometimes difficult) have the capacity to feel and receive the outpouring of love in the moment. Encourage your child to talk about feelings and observations; your child may reveal things you haven’t previously addressed that could be an underlying cause for concern. As much as you can, help them to comprehend that you, too, can empathize with their feelings. Further, help them understand that their grandparent or other relative with cognitive decline did not choose the disease and that the changes happening inside their brain is what is causing the memory and behavior problems. For you as a parent, read over related materials to help with these discussions. Try involving your child with the loved one with dementia or Alzheimer’s by engaging them in simple activities like listening to music, setting the table, or creating memory boxes. Above all, you and your child can come together to devise ways of showing your love and support which helps you both to keep an open line of communication available for everyone involved.  
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