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Photo used under Creative Commons from jenny downing.
Alzheimer’s disease develops gradually over the years, usually going unnoticed at first but eventually becoming impossible to ignore. What signs should families be alert to? The key is to look for major changes that interfere with everyday life.
Some examples of actions that might be taken by a senior with Alzheimer’s include:
- Forgetting things that are part of a well-established routine, and were once done without fail.
- Repeating questions.
- Arriving somewhere without any idea how they got there.
- Losing their way on a familiar route they take every day.
- Forgetting to turn the stove off.
- Leaving doors open.
- Forgetting to eat meals.
- Unusually poor hygiene that the person is not aware of.
- Placing objects in unusual places.
- The inability to remember even basic words, or speaking in such a way that’s hard to follow.
- Sudden mood swings for no particular reason, or becoming uncharacteristically suspicious or trusting.
- Lack of awareness of strange behavior.
Deciding to enter hospice care is never easy. Everyone involved in the decision may find themselves experiencing regret, sorrow, and confusion about what to expect. While issues of death and dying are always extremely difficult, knowing what to expect can help make the process a little more bearable.
Most know hospice as a form of care for those who are suffering from terminal illness. It’s more than just medical care, however, as clergy and social workers may be part of the hospice team in addition to physicians and nurses. Hospice helps patients and their families come to terms with this difficult event. The main goal of hospice is to make the final days of a dying person’s life as painless and comfortable as possible, while helping to bring about a sense of resolution.
One of the main qualifications in order to be eligible for hospice is that the individual must be expected to live for no longer than six months. In most cases, if the person requires additional time, their physician can extend their care. Hospice can be discontinued if the person receiving it begins to recover.
One of the first steps in going about retaining hospice services is to consult with the loved one’s primary care physician. You can also contact a hospice group or a facility, such as Raya’s Paradise, that provides hospice care. Once a hospice team is assembled, all aspects of the patient’s care will be considered and a comprehensive plan will be developed. This would include the patient’s comfort level, finances, necessary medical care and medication, as well as religious beliefs.
When determining whether hospice is appropriate, physicians will usually use the Karnofsky Performance scale. This is a set of criteria to help evaluate the patient’s general health in order to determine life expectancy. Common diseases that usually resolve in hospice include cancer and Alzheimer’s disease.
Some may consider opting for hospice to be giving up. This couldn’t be further from the truth! In fact, it takes a very strong person to be willing to accept help and support when it’s needed. This is not a matter of giving up, but more of doing what’s necessary at that point in time. Furthermore, by choosing hospice, your loved one will receive increased comfort and support, leading to more fulfilling and meaningful final months of life.
Discussing hospice is never easy. Nobody wants to be the first person to bring up the topic of death and dying. If you or someone you love is considering hospice, it’s important to realize that not saying anything could in fact delay hospice and cause unnecessary pain. Hospice is all about making the last stage of life as comfortable as possible. There’s no point in prolonging discomfort. Take a moment to begin the conversation now and you may help ease the suffering of a loved one.Unfortunately, there are some out there who will mistreat those who are vulnerable, including the elderly. At a certain point, it becomes elder abuse, and it’s one of the worst fears of those who have a loved one who is not fully able to fend for themselves. Elder abuse can be inflicted by a staff member in a residential institution, a fellow resident, a hired caregiver in the home, or even a family member. Our seniors deserve our gratitude and our respect, but a significant number of them are victimized and disrespected by the very people they trust. They cannot always do what it required to keep themselves safe.
Elder abuse is under-reported because so few of those who are harmed by it can speak out for themselves. Because of this, it is important that family members, assisted living staff, and friends know the signs and symptoms of elder abuse. Being able to recognize abuse is the first step to putting a stop to it. There are several types, including:
- Malnourishment – refusing to provide required food or water which can lead to serious medical problems, starvation, dehydration, and sometimes death.
- Physical Abuse – committing physically violent acts; punching, kicking, slapping, pushing, and pinching are a few examples.
- Sexual Abuse – committing unwanted sexual acts; molestation, harassment, rape, forced oral sex, and unwelcomed sexual language are considered forms of sexual abuse.
- Financial Abuse – refusing seniors access to their own money, stealing, or embezzling.
- Refusal of Medical Care – refusing them access to their physician, or refusing to provide them with their required treatments or medications.
- Psychological Abuse – verbal abuse, name calling, demoralization, refusing seniors access to psychological care
- Emotional Abuse – refusing them access to loved ones, telling them that no one loves them or wants to visit with them, making them believe that they are alone and utterly unloved.
- Neglect – not providing seniors with the necessary hygienic care (bathing, brushing their hair, changing their diapers), leaving them alone for long periods of time, not providing a clean, safe and comfortable environment (no heat or air conditioning, allowing for filthy living conditions), or allowing others to abuse them.
- Unexplained or poorly explained bruises, broken bones, burns, abrasions, and pressure marks
- Sudden changes in personality not explained by mental illness
- Tension in personal relationships with family, friends, or assisted living staff
- Unexplained withdrawal from activities that used to bring joy
Few things can brighten a senior’s day like a visit from their grandchildren and great-grandchildren. These visits can help add purpose to a senior’s life and help them maintain a connection to a world outside the facility and to the family. It also gives the grandchildren a valuable chance to get to know the grandparent. Being able to see how much they mean to older family members is an important experience for the child. But it can be challenging to think of ways to make this time meaningful and enjoyable.
The first step is to prepare the child for visiting the facility. Describe what it’s like and perhaps even show pictures. Explain the purpose of assisted living and why the family decided grandma or grandpa should be there. Explain what behavior will be expected. Be sure to emphasize how happy the senior will be to see the child, but also make sure they know that their grandparent may not be feeling well that day.
What to do during the visit can be a challenge. If everyone just sits around in grandma’s room, it will be boring for the children and unsatisfying for the senior. Instead, have a plan. Here are some ideas:
- Bring children at a time when the residents are socializing. That way, the senior can introduce the child to friends and have a chance to show off their wonderful grandchildren.
- Wear Halloween costumes so that the grandparent can see in person how cute they look and what creative ideas everyone came up with. There may be other holidays where the children are dressing up, such as Purim or Christmas, and they can show their grandparent their special outfits for these times too.
- Have children bring a recent school project that they can show to their grandparent. Seniors are likely to be very interested in seeing what kids are learning in school these days. If the project is about something the senior doesn’t know about, that gives the child a chance to be the teacher.
- Play games. The child can bring a favorite game to share with the grandparent, and it’s likely that the grandparent has a favorite game of their own that they can teach the child.
- Decorate the senior’s room for an upcoming holiday. Decorations often bring out lots of excitement in children, and seniors will feel loved and have a reminder of the visit after the children have left.
- Share riddles and jokes and silly songs. Children might be very interested to hear some of the songs the grandparent remembers from when they were the child’s age.
- Bring photographs or video of a recent event in the child’s life, such as a chorus concert, ball game, or scouting trip. Have the child tell the grandparent stories about what happened.
- If you’re willing to take on a bigger project, talk to the assisted living facility and the child’s school about arranging a class visit. The children could sing for the seniors or perform a skit. Another idea is to have children interview the seniors about their lives, and use the information to write short biographies that can be compiled into a collection for both seniors and the children to keep.
Seniors entering assisted living may need help with daily tasks due to the physical limitations of old age, but often their minds are still relatively healthy. These seniors can benefit from taking simple actions that will help them continue to maintain their mental abilities.
1. Take on puzzles and games. Exercise the mind with logic challenges to keep it active. Card games are a great example: those seniors who enjoy bridge, even without realizing it, are doing more for themselves than simply having a good time enjoying competition with friends. Board games like monopoly are good choices too, and don’t forget the ever-popular Bingo (play with multiple cards to get the most brain-stimulating challenge)! Sodoku and crossword puzzles work well. The best benefit from games comes when there’s a social aspect to them: interacting with others provides additional stimulation and challenge.
2. Be social. If you’re not someone who enjoys games, even social interaction itself can benefit the mind. Talk to other residents and get to know them. Take an interest in the staff members you come into contact with and ask them about their lives outside of work–with their demanding and sometimes emotionally draining jobs, many caregivers will appreciate the chance to make a personal connection and be recognized. Check out activites being offered by the community. Social interaction has had documented positive effects not just on the mind, but on overall health as well. Seniors in assisted living, who have a community readily available, are well-situated to take advantage of these benefits.
3. Eat properly. Good nutrition and regular meals are good for both the body and the brain. Your assisted living facility can be a big help with this, providing healthy food on schedule without you having to worry about it. Eat a variety of things and for mental benefits specifically focus on colorful fruit, leafy green vegetables, and foods with omega-3 fatty acids like nuts and fish. Drink water often: seniors are more likely to become dehydrated than younger adults.
4. Move. We think of exercise as benefiting the body, but our minds thrive on it too. Don’t shy away from the chance to be active. Coordinated movements, especially dancing, can be great for keeping yourself sharp. Line dancing, for example, forces you to use your memory to learn and remember the steps. Another option is to go for a walk, even if it’s just around the hallways of the facility. Seniors have been shown to benefit from light strength training and low-impact aerobic exercises designed for them. Physical activity increases your oxygen use and blood flow to your brain. Whatever exercise you choose, to get the benefits it’s important that you be consistent.
Many of us have pets we love dearly in our lives. Seniors often find pets to be good companions when they live on their own. Indeed, studies have shown that having a pet is great for one’s health. However, pets often cannot move with a senior to assisted living, and even if they can there’s many reasons why it might not be a practical decision. What will happen to the pet is often the biggest concern about the move.
It’s common for people to feel wracked by guilt over abandoning a beloved friend they have taken on the responsibility to care for. However, this guilt is misplaced if the senior is having trouble caring for the pet and it would be better off with other owners. Seniors who are ready for assisted living may have trouble with taking the dog for a walk, feeding or cleaning their pet, or getting to the vet or to the store for supplies. Indeed, families concerned about mom or dad can get a clue to how well they are able to be on their own by observing how the pet is doing.
One possible solution is for the senior’s family members or a friend to adopt the pet. They can bring the animal to see their loved one regularly. Even if the pet cannot come into the facility, the senior can be brought outside to say hello. This is the ideal solution for reducing the trauma of pet separation.
If this is not possible and the senior doesn’t know anyone, even living far away, who can take the pet, it will probably have to be surrendered to a shelter. Giving the animal away to strangers is not always a great idea, as they can end up with an abusive or irresponsible owner. Seek out a well-funded “no-kill” shelter to receive the animal. It’s a good sign if you have to make an appointment to surrender the pet: this shows that the shelter is working to manage their intake of new animals. There’s a good chance the pet will find a new family. Find out in advance if your pet has any issues that will make it “unadoptable” in the shelter’s eyes. Especially if the pet is old, make sure to provide the shelter with veterinary records.
If a loved one entering assisted living is bereft over the loss of a pet, try to compensate with plenty of human companionship. Make sure that the senior’s family and friends visit often. Feeling involved in a community can help with the loss.
Meetings can be very useful when a family is faced with a tough decision, like whether to move a parent to assisted living. They provide a chance for relatives to come together, pool their knowledge, and discuss various options and strategies.
It can be tough even to make the decision to hold such a meeting. The most important family members may not all live close together, so location is a challenge. People’s schedules are packed and some may be reluctant to add one more thing to the calendar. Sometimes it’s assumed that other relatives don’t want to get together. However, it never hurts to ask. Due to the serious nature of the decision, people may be more inclined to be cooperative. And if their lives are heavily affected by caring for mom or dad, they will be interested in solutions that will improve the situation.
It is important to include the affected senior, even if it means overcoming challenges presented by physical or mental disability or resistance to facing the need for care. There are several reasons why you may feel this is inappropriate, but making sure your loved one is included in the process is vital to making any solution work. They deserve the respect of knowing that they have say in decisions affecting their life, and you can’t find a solution for them unless you have their own opinion on what their needs are. You may be surprised to learn how they see the issue. This does not mean that the solution mom or dad would choose on their own is necessarily the best one and that they have final say, but you do need to take into account their concerns.
Consider including any paid caregivers or others who provide household services. The cleaning lady who comes in on Fridays may have noticed something you haven’t. Also consider bringing in the senior’s friends and neighbors. A social worker or for families where religion is important, a spiritual advisor, may also be helpful.
Try to plan the meeting at a time when it’s easier for far-flung family to travel, perhaps during the holidays. When planning the agenda, make sure everyone will get a chance to speak so that they can make their case for what is important to them, and be sure to devote significant time to what the senior has to say themselves. Have everyone in the group review the agenda in advance. Also choose people to take on different tasks: someone who can be a neutral facilitator, someone to take notes, someone to keep time. Plan to hold the meeting in a place that will comfortable and have food and beverages available. Try to choose somewhere that allows a layout where everyone can make eye contact with one another.
Tension exists in any family, even those where the members are close and get along well. It’s a normal part of life. Bringing everyone together at once will cause these problems to rise to the surface. Keep conflict to a minimum by focusing everyone on finding solutions for the future, not on rehashing past grief. Remind everyone that there will be no perfect solution and there will have to be compromise in some form. You won’t be able to fix everything then and there. The point is to gather perspectives and come up with practical answers.
When you’ve finished the meeting, send the notes to people who were interested but unable to attend, and follow up on whatever course of action was agreed upon. Even if you decide that assisted living is not the right choice now, in time your parent is very likely to need help. Make plans to have them visit facilities you are considering and prepare for an eventual move. It never hurts to have alternate solutions available for when they might be needed. The one thing you can always count on is change.
One of the hardest things for seniors living on their own is having meals that are both nutritious and enjoyable. Cooking for one person is tough enough when you’re young and energetic, but when everyday tasks are more difficult and you move more slowly, it’s that much more difficult. Some seniors can’t get out to the grocery store to even get food to begin with. Especially when it comes to men and others who may not have done much cooking earlier in their lives, making your own meals can seem like an impossible task. In these situations, seniors tend to go for what’s quick and easy, not what would be the most ideal choice from a health standpoint.
In addition, seniors living by themselves eat alone much of the time. Having dinner with only the TV for company can be pretty lonely. Even if the senior lives with family, how often in busy homes with kids does everyone come together to share a meal? Despite the living situation the end result may be the same: a microwave dinner in front of the evening news while children stay late to deal with work responsibilities and grandchildren attend basketball practice or reherse for the school play. This scenario may make the senior feel even more cast aside.
To be fair, some seniors are still excellent cooks and can fend for themselves. But the chances are good that sooner or later, food will become an issue. When it does, it can contribute to making a senior’s delicate health even worse. Poor nuturition makes people more likely to get sick, can exacerbate conditions like Alzheimer’s and dementia, and can lead to depression.
Those who are concerned about their older loved ones should not wait for the senior to ask for help, as sometimes they will fear the loss of their independence and hide problems. Watch for clues like excessive weight loss or a refrigerator with barren shelves or expired food. Consider whether getting to the grocery store is a challenge: does the senior have trouble getting outside his or her home? You also may want to ask if he or she is having problems with swallowing or chewing or if they’re experiencing a loss of appetite.
This is one area in which assisted living can make a big difference in a senior’s life. Assisted living residents do not have to worry about cooking for themselves. They get to have regular mealtimes within a community and experience the comfort of gathering together with people they know. A good assisted living facility will make sure the senior gets the proper diet for his or her specific health issues.
We all feel happier when eating well and enjoying good company. Attention to this area can be a huge boost in a senior’s quality of life.