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Giving Dignity to Dementia Patients

How to treat dementia patients with dignityOne of the most tragic aspects of dementia is watching a person who you once knew to be capable, independent, and thriving now have difficulty with basic tasks and revert to a childlike state. There’s often great pain as your loved one knows that they’re regressing but is unable to regain the abilities of their younger self. It may seem like this decline is out of anyone’s control, but there are some ways that you can help to lessen its sting. First, pay attention to how you’re speaking to your loved one. There’s a tendency for us to talk down to the elderly and treat them like children. Are you being condescending? It may help to separate the person’s illness, which may result in strange and childlike behavior, from who they are essentially as a person. Mom is still there behind her dementia, and you want to honor her. Also think about your vocabulary. Are you using words that you might use with a child but not when talking to your loved one before the onset of dementia? Try calling adult diapers underwear or the “potty” the bathroom or whatever your loved one has always called it. In conversations, avoid putting your loved one on the spot by asking questions they may not be able to answer. Try to stay away from facts that can be wrong or right, and instead ask how they feel about something. For example, if someone who doesn’t know your mother asks her how many grandchildren she has, redirect the conversation by getting her to talk about how much she loves them instead. Many caregivers strategically use what they call “therapeutic fibbing” to help their loved ones. For example, dad insists he wants get in his old boat and go fishing by himself the way he used to. Don’t tell him he’s not capable of going out on the water on his own and his boat has been sold anyway, as this will likely make him feel upset and depressed. Instead, you can tell him today’s not a good day because there might be a thunderstorm coming, or that the boat’s engine needs to be repaired. Each and every one of us needs respect and to feel important. Try to encourage and reassure your loved one that they have value as much as you can, and speak with other family members about doing the same. Your loved one may no longer be the exact same person they once were, but with a little cooperation and assistance from those around them, you can minimize embarrassing situations and despair.
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Discussing Alzheimer’s with Family Members and Friends

Stigma against Alzheimer's prevents seniors from getting diagnosed.An Alzheimer’s diagnosis can be isolating, both for the person with the illness and for their caregivers. Illness can often create distance between those who were once close, and the nature of Alzheimer’s disease compounds the problem. Others are unsure if the person will remember them or if they’ll behave inappropriately. Still others may remain in the person’s life, but not acknowledge the disease at all, and thus leave a big silence about a major life event. Many people who suspect they have Alzheimer’s avoid an official diagnosis because they fear the effects on their social world and the painful feelings of rejection and loneliness that would come with it. However, it is vital that patients get a diagnosis so that they can receive proper care. If someone close to you is going through this important turning point, here’s how you can help. Listen before judging. A time like this is ripe for family conflict. Should the person get diagnosed and when? If they do have Alzheimer’s, how will the family plan for the future? It may be that the Alzheimer’s patient has disagreements with the rest of the family, or people within the family are fighting among each other. You will have your own opinion on the issues at hand, but make sure you’re hearing out the other side and giving their point of view fair and compassionate consideration. Hold back on stating your viewpoint and ask others for theirs first, to make sure they have a chance to give input. A third-party mediator may be able to help if you worry that conflict will get out of control. Be supportive. One of the best things you can do for your loved one is to help them think through all the choices they have to make at this time. This may require you to keep your own emotions in check at a time when you might be feeling a lot of fear, so it may not be easy. Keep in mind that your loved one will likely be afraid of seeming to be needy or a worry-wart. Encourage them to talk through their concerns rather than keeping them private. Stay calm. At this time it’s very important to be patient, and not all of us count this as one of our strengths. But keeping your cool can go a long way towards maintaining a positive relationship with your loved one that will keep them open to your much-needed help. Remember that pointing out that you were right or expressing negativity may not be the most productive course of action. Put a focus on keeping a good relationship. Using these skills will put you in a position not only to support your loved one, but also help you bridge the gap between them and family and friends. You can play an important role in keeping the peace.
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How to Handle Hallucinations and Delusions

Dementia patients may experience hallucinations.One of the more unnerving side effects of dementia are the delusions and hallucinations these patients sometimes suffer. They can leave the patient very troubled and scared, yet they’re difficult for loved ones to address because they know these illusions aren’t real. Around 25% to 40% of dementia patients experience these episodes. They will often respond with agitation, aggression, or even violence. This behavior may be more threatening and troubling as the disease advances, as patients are more likely to respond to what’s going on in their minds. Your initial instinct might be to try to reassure your loved one that what they’re seeing isn’t real. But this is often a mistake. The patient can easily get the perception that you don’t take them and what they’re seeing and feeling seriously. Rather than being comforted, they may feel isolated and hurt. Instead, what you’ll want to do is offer some acceptance to their reality. No, you don’t have to believe that mom’s long-dead sister is in the room with you, but you should understand that the experience is real for your mother. If you do this, you’ll bring stability to the situation much more quickly than if you tried to fight them on what they’re perceiving. Be reassuring: “You must feel frightened. I would be frightened too. But I will stay here with you to make sure you’re safe.” It may also help to offer some form of physical comfort, such as a touch on the arm. No only does this reinforce that you are there for them, but also helps draw their attention towards you and away from what’s bothering them. You can also help make the problem vanish by getting your loved one to a different environment like another room or outside for a little fresh air. Some hallucinations might be comforting. Dad may be imagining that he hears birds pleasantly tweeting. If he seems to be happy about this, you may not want to disrupt this at all. You only really need to worry if what your loved one is perceiving puts them or others in some kind of danger. Unfortunately, you won’t always be so lucky and there isn’t much you can do to prevent these incidents. Medication may help, but it may have side effects that bring new problems. Understand that feeling distressed and overwhelmed in these situations is normal. By learning all you can about this effect of dementia, you can help yourself to cope with it more effectively.
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The Process of Alzheimer’s Memory Loss

Alzheimer's memory lossHow memory loss in Alzheimer’s patients works may at first seem mysterious to those whose loved one’s are suffering from the disease. The senior can tell stories about their childhood, but doesn’t remember that they had lunch just a half hour ago. It just doesn’t seem to make sense. First, it may be helpful to learn a little bit about the nature of memory. When a person who does not have Alzheimer’s undergoes an experience or learns a piece of information, a part of the brain called the hippocampus plays a role in taking in that new tidbit. However, in Alzheimer’s patients the hippocampus is one part that suffers first, thus preventing new memories from registering properly. Also, memories that have an emotional component to them are stored separately from other memories. This may explain why dad can’t remember what he did with his glasses, but can talk about his service during the Korean War. As the disease advances, even older memories stored elsewhere in the brain begin to disintegrate. Also, plaque builds up in the nerve cells in the brain, which may lead to disorganized thinking or confusion. Unfortunately, there is nothing we can do yet to stop this process. However, you can help a loved one with Alzheimer’s by sticking to a routine. The regular schedule will help them be more comfortable and feel less confused. Also try to reduce the amount of extra stimulation, such as noise, that the patient is subjected to. All the additional activity can contribute to disorientation. It can be very stressful for caregivers to watch their loved one lose their memories, especially their most-cherished ones. During this time, be sure to take care of yourself. Seek out friends and family who can give you support. Caregivers can too easily feel alone and shut themselves in their own worlds. Don’t let this happen to you. You might find it helpful to learn as much about Alzheimer’s as you can, so that you know what to expect. Never take your loved one’s forgetfulness personally: it is the disease that is causing your dear Aunt Judy to forget your name, not any lack of love on her part. And finally, choose to make light of the situation as much as you possibly can. Yes, the pain will still be there, but if you can laugh about the effects of the disease, you can manage to ease the negativity you may be feeling.
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Alzheimer’s 101

Alzheimer's introductionIf you or a loved one has recently been diagnosed with Alzheimer’s disease, you probably have a lot of questions. This article is intended to address some of the most basic facts and get you started in the learning process. Alzheimer’s disease, which is the most common form of dementia, is a problem with the brain and affects a patient’s behavior, thought processes, and memory. The symptoms are fairly minor to start, and then gradually get worse to the point where they drastically affect the individual’s everyday life and they need other people to help them complete even basic functions. There are several million people in the US who have Alzheimer’s disease. It usually starts sometime after 65 years of age, and becomes more likely the older a person gets. Among those people older than 85, some estimate that half have Alzheimer’s. One of the first signs of Alzheimer’s disease is problems with thinking skills, especially memory, and behavior alterations. The person may be moody, restless, or confused. They may display uncharacteristically poor judgment or have trouble processing visual information. They may also experience difficulties communicating and using language. Alzheimer’s can be difficult to diagnose because its symptoms can easily seem like the normal effects of aging. The disease is frequently ignored in the early stages. How can you know the difference? When you see the doctor for a diagnosis, he or she will run a variety of tests designed to measure cognitive functioning and behavior. The only way anyone can know for sure that a person has Alzheimer’s, though, is to see if there is plaque in their brain tissue. This usually isn’t possible until after the patient has passed away and an autopsy is performed. The disease may take anywhere from around 5 to 20 years to run its course. Because it damages the brain, it can cause a person to have trouble with basic physical functions such as swallowing, which can in turn lead to death. Alzheimer’s patients are also more likely to get an infection. As of yet, no cure has been found for Alzheimer’s disease, but there are treatments available that can lessen some of the negative effects of the disease on patients and caregivers, as well as slow its progression. To learn more about this disease, see the articles below: How to Choose a Memory Care Facility When Your Parent Forgets Who You Are Three Big Questions to Consider After an Alzheimer’s Diagnosis
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Addressing Agitation in Someone Who Has Dementia

Old woman's hands tucked between her legs

Used under Creative Commons by Horia Varlan.

A dementia patient’s agitation is one aspect of the disease that can be distressing to family members. They may fuss and fidget or repeat certain phrases. They may scream out or ask the same question over and over again. For some family members, this is the aspect of the disease that inspires the most dread. This behavior may have a variety of causes. It may be that something in the person’s environment is bothering them. Or they may be trying to complete a task that is too complex for them. Or the behavior could simply be due to changes in brain chemistry. There are ways that families can address agitation and help the dementia patient become calmer. First, determine the root cause of the agitation. If it is something specific, such as a runny nose or a room that is too cold, you may want to simply address the problem if all it requires is a sweater or a tissue. Another technique to try is to remind your loved one of an activity they used to enjoy. For example, if your mother stayed at home to raise four children, you could give her a baby doll and get her to tell you stories about when you and your siblings were growing up. Or if your father used to pride himself on his garden, take him outside to look at the flowers or maybe even do a little pruning. He may no longer be capable of carrying out more advanced tasks he used to be able to do, but it’s likely he’ll take pleasure in re-learning simpler ones. Re-directing the patient’s attention on something they enjoy can have surprisingly powerful effects. Some professional caregivers have even found that this technique reduces the need for medication. Whatever you do, avoid confrontation and try to remain calm. The tone of your voice matters more than you think, so try not to let your frustration or annoyance show. Try to distract your loved one from whatever might be irritating them. Don’t try to rush your loved one along; let them move at their own pace. When deciding how to address a loved one’s agitation, be flexible and consider a variety of solutions, depending on the cause. There is no one magic way to address this behavior. Instead, try to find different solutions that work at different times, and consider them part of your toolbox of ways to respond to the disease.
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Exercises for the Later Stages of Dementia

Simple movements are all it takes for late dementia paitents to get exercise.Those in the later stages of dementia may have lost much of their former mobility, but that doesn’t mean that they can no longer exercise, or that it isn’t beneficial to do so. As discussed in an earlier post, dementia patients can slow the progress of the disease by working some activity into their daily routine. We’re not talking jogging and playing volleyball, but rather simply moving and experiencing some physical challenge. Here are a few exercises that those in the later stages of dementia should be able to complete:
  • Encourage your loved one to stand up and move around as much as possible. This will maintain strength in the legs and help with balance.
  • Have your loved one lie flat on the bed for up to a half hour. This will give the neck a break and help him or her stretch out.
  • Help your loved one sit without support. They should not try this out when they’re alone, as there’s a chance they may fall. This will aid the muscles in the stomach and the back that support posture.
  • Your loved one can also stand and balance. If they need to hold onto something for support, they’ll still get some benefit. They can even try this any time they have to stand for a few minutes, such as in the shower.
  • Have your loved one sit on one end of the bed, and then scoot to the other end while sitting. This exercise is good practice for getting up from a chair.
In general, encourage as much movement as possible. The key is to push oneself just a bit to help slow decline. Of course, pushing too far will result in your loved one getting hurt, but not moving at all and always staying comfortable isn’t great either. Be sure to observe your loved one carefully for signs that they’re over-exerting themsevles. When starting an exercise routine like this with your loved one, go slow. Try to just add one thing each day, rather than dramatically changing their routine. Just like younger exercisers, trying too much at once will just lead to an injury or dropping the whole thing. The most sustainable change is gradual, and this is all the more true for dementia patients, who get anxious with change. Also remember that completing exercises perfectly is not the goal: simply moving is. Be encouraging even if your loved one is having trouble. It may be that what they can’t do today, they’ll be able to do tomorrow. As always, speak to your loved one’s doctor about how much movement they can handle.
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Exercise Benefits Dementia Patients

Physical exercise is beneficial for seniorsWe know that exercise is important, but sometimes we forget that that applies to seniors too. Getting some form of exercise can increase the quality of life for dementia patients and keep them healthier. One study even found that seniors who exercise pay less in medical bills! Of course, high-impact aerobics or a Muscle Beach strength routine wouldn’t be appropriate for most seniors. But there are plenty of exercises that they can do. Below are some suggestions for those in the earlier stages of dementia. Our next post will offer exercise suggestions for those in later stages. Walking Walking is perhaps the most basic exercise of all. To get started, all you need is your own two feet. It’s easy to design a walking routine to fit what that particular person is capable of: they may take a walk around the neighborhood or simply down the hall and back. Two friends can even go for a walk together to combine physical exercise with socialization benefits. Tai Chi Tai Chi is a slow and graceful form of Chinese martial arts that’s been shown to reduce stress and improve balance and stability. It can be thought of as a form of moving meditation, more gentle and relaxed than yoga. Its movements are perfect for seniors due to the activity’s easy, gentle pace. Swimming Many seniors enjoy swimming, finding it to be a relaxing activity in which movement is less jarring to the joints. If your loved one enjoys the water, this could be the perfect activity for them. Keep in mind that seniors with dementia should be supervised while swimming. Dancing You don’t need to be fast and build up a sweat to be dancing. You can even dance while sitting down! For seniors, swaying back and forth can be beneficial. The music and the fact that dancing is usually done with others adds social and emotional advantages to this activity. Gardening Even if your loved one wasn’t a gardener earlier in life, they can still take up this pastime now. Simple activities like weeding or watering don’t require a green thumb or prize-winning expertise. This activity provides the sensory benefits of the colors, smells, and textures, and also allows seniors to take meaning from the effort involved in making something grow. There’s a certain satisfaction in achieving results, no matter how simple. Seniors should get the same amount of exercise as the rest of us: 30 minutes for five days per week. This may sound like a lot, but keep in mind all 30 minutes don’t need to be done at once. Be sure to consult with your doctor before beginning any exercise routine.
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When Your Parent Forgets Who You Are

Photos can help Alzheimer's patients remember loved ones.On your last visit, Mom seemed kind of down so you’re determined to cheer her up today. You open the door to her room. She looks up with a smile that reminds you of the days you’d run home from school with a 100 on your spelling test. She rises and gives you a big hug. “Ella, I am so glad to see you. I was beginning to think you’d forgotten all about me.” She’s showing more enthusiasm than she has in weeks. So why is your stomach in free fall, and your heart pounding to beat the band? It’s because your name is Barbara. Ella is Mom’s older sister who died four years ago. What do you do? You want to keep her spirits up, but you don’t feel it’s right to play along. Mistaking children for siblings or other loved ones is not uncommon in Alzheimer’s patients. Alzheimer’s patients lose short term memory but not their recall of the past. You look after her interests. You make sure everything’s going well. You’re her protector, just like big sister Ella used to be. Seeing you may have caused a cross wire. When Mom recalls her long ago, it’s like she’s living in a dream. Now you’re here but the dream remains. She’s made you a part of it. You want to wake her up, but gently. There are several things you can do. But first and foremost, do not take offense. Think of her misrecognition as a compliment. She’s connecting you with someone she loves. Secondly, do not argue with her. Don’t make her see. Help her see. Listen to her, let her say what she has to say, then try to re-direct her focus. Switch the topic. A change of scenery may help. Suggest going for a walk. Address her by name – Mom. Hearing that one word may be all it takes, but it may not always work. It’s in both of your interests to try to prevent this from happening again. Here’s a suggestion you may want to try. This may even be fun – for both of you. First, gather up all the old photos you have at home. Scour the basement or the attic. What you want is a time line of Mom’s life: as a young mom, with you and all your siblings, and on through all the stages of the family’s life If you’re lucky you can extend it even further back, with photos of Mom when she was a child – with Aunt Ella. This may keep her in the present and if nothing else, will be an emotional bonding experience for you both. Next, gather some present time photos. You, Mom, your siblings, the grandkids, if they visit. That’s all you need. You don’t want to confuse her or you’ll be back where you began. Bring some cute labels. Make it a project. Label each photo, and create a timeline from past to present. This may help to trigger mom’s memory about who you are, by connecting an image of you from the past with what you look like now. Hang the timeline in a prominent place in her room. Finally, you don’t want to go down this path again, so next time you visit, identify yourself – face to face. “Hi Mom! It’s your daughter Barbara.” If mom has a favorite nickname for you, refer to yourself that way. If you can keep her in the present, there’s no need to bring her back.  
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The Stages of Dementia

dementia decline goes through seven stages

Used under Creative Commons by Public Places.

If you have a loved one who has dementia, what can you expect as the disease progresses? The stages below can give you some idea. Each individual’s experience is a little different, but this outline can give you a sense of what the future holds. Stage One During Stage One, no symptoms are present. Even a doctor would not be able to immediately tell that the person has dementia, and the person themselves doesn’t notice anything wrong. Stage Two Stage Two brings some mild changes in cognition. During this stage, it’s hard to tell whether memory problems are the beginnings of dementia or just changes that take place with normal aging. The person will forget words and names and also lose things. Stage Three Now other people besides the senior begin to notice that there’s a problem. The person will lose valuable objects, forget what they’ve just been told, and start to have trouble at work or in their social life. They may get lost on the way to a familiar place. Stage Four At this point, it’s time for medical attention. The person becomes more and more forgetful, even to the point of forgetting parts of their life story and people they know. More difficult mental math problems are now out of reach, and their ability to concentrate decreases. Their personality also begins to change as they withdraw from others and are moody. Stage Five In Stage Five, others will clearly be able to determine that a person has dementia, and the individual will start to depend on caregivers for help. They’ll forget information that they need from day to day, like the names of family members. The person might dress inappropriately and be confused about what happened when. Stage Six Caregivers and other loved ones will find this stage to be the most challenging. Some patients will have trouble sleeping or will wander. They are also likely to need help using the bathroom or getting dressed. They’ll experience delusions, become anxious and obsessive, and forget even information as important as the name of their spouse. Stage Seven Finally, the senior will need help even with very basic tasks. They’ll have great difficulty speaking and expressing their emotions. They’ll also need assistance almost constantly, to do even simple tasks like eating. Walking may be impossible. It’s not easy to watch a loved one decline, but knowing what to expect can make it a little bit easier. Our articles for caregivers can provide you with ideas for how to make this time happier and more comfortable for your senior, as well as how to best take care of yourself.
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