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What are the effects of pain on agitation?

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February 17, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Confusion and/or agitation almost always increase when pain is present. Furthermore, if there’s a sudden increase in confusion or agitation, it should be a tip-off that something wrong is going on physically. Dementia does not typically progress that rapidly. There is a cycle of pain that gives us a picture of how pain can affect the entire body. It goes something like this: Pain, anxiety, fatigue, depression, pain, anxiety, fatigue, depression, pain … and so on. If a person who has dementia is in this cycle and unable to let anyone know, we have to intercede and determine what’s really happening. The sources of pain can be numerous. Most people forget at least a few when listing them. A partial list includes: arthritis (the No. 1 affliction of older Americans), joint and muscle problems, infection, inflammation and headaches. If your loved one has chronic problems or even just a history with any of these conditions, ongoing visits with the physician (who presumably will prescribe some form of treatment) are critical. Ongoing assessments by a doctor or other clinician are very important. By examining overall health frequently, a clinician can learn whether something like a headache, urinary tract infection or other condition is a sign of something bigger. Be sure to keep the physician informed, even when you’re not going to see him or her in person. Watch your loved one’s facial expressions and body language since they are common indicators. Something as simple as a flare-up of arthritis or a foot wore can cause a change in behavior. Also be aware that some medications can cause agitation. Always call a physician if you have any questions or concerns about medication issues or effects. Caregiving involves ever moving targets so constant assessments and questions should be a part of it. Talking with others in your position can help. Discussions with other caregivers, whether they’re in a support group you’ve joined or are on their own, can be a good source of support. Family members and friends who sincerely care and try to understand are other good resources. There is no need to think you have to go through these challenges alone. Reach out for, and accept, help often. There are many good sources out there, including this free booklet: “The Indispensable Alzheimer’s Resource Kit.” Click here to get it sent to you for free.  
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Sometimes words don’t seem like enough when trying to communicate with someone with dementia

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February 16, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Nonverbal communication is important, more so perhaps with someone who has Alzheimer’s or dementia than with others. That goes for communication in both directions: from you and to you. Body language can be responsible for up to 80% of all communication. It is very important therefore, when communicating with our loved ones to do more than just get the “right” words. Facial expression and tone of voice are a big part of your message. Alzheimer’s patients are still sensitive to people around them and can be rather intuitive. They know when someone is not being sincere. Similarly, they can be very aware if they’re being excluded from something or being talked down to. People with Alzheimer’s can sometimes look into your eyes and seem to read your soul — like a “sixth sense.” Be aware of the body language they may be sending your way. Bouncing up from a chair and pacing around could indicate, for example, that a visit to the restroom is warranted. Or it could be an indicator of some type of pain or discomfort. Always keep in mind that pain could be a part of the equation. As for calming your loved one’s agitation or anxiety, sometimes less is more — as in talking less, or not at all. Sometimes you don’t need to say anything. Touch is an important part of the human condition, so resort to hugs and gentle touches on the hand, arm or shoulder often, if you can. A simple hug can dramatically change a person’s mood instantly. Sometimes, an angry caregiver might not want to give a hug, but that’s the time when your loved one might need it most. Embrace her, and the opportunity to improve one’s existence. It might be stepping out of your comfort zone, but the results could amaze you. A hug can release tension immediately (in your loved one and you). A gentle massage or back run also can soothe the mood and have a relaxing effect. For more information, download the Indispensable Alzheimer’s Resource Kit which can be obtained at no cost by clicking here     
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How can I minimize my loved one’s agitation while trying to communicate with her?

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February 15, 2012

- Alzheimer's Care, Blog, Elder Law Articles

An important part of any type or relationship is communication. An often tough task becomes increasingly difficult, however, when a person with dementia is involved. Both processing and expressing information become more difficult, which can lead to frustration, which can ultimately manifest itself as agitation. Anything from mere pacing to lashing out can be a sign of agitation. As a caregiver, you want to avert agitation as much as possible. Effective communication can help. Below is a list of ways to improve communication. It is by no means complete, but if you follow these tenets, you’ll be doing well:
  •  Talk with a calm presence
  • Don’t argue — you’ll never win
  • Validate feelings
  • Smile and be pleasant
  • Approach from the front so you don’t startle your love one
  • Identify yourself, if needed
  • Maintain eye contact
  • Ask one question at a time
  • Go slowly. Remember that hurrying heightens frustration
  • Use short sentences
  • Give plenty of time to respond
  • Repeat information as needed. Repetition is good and usually helpful
  • Use touch, such as on the shoulder, knee, back or hand
  • Give hugs — many times a day
  • Laugh together
  • A high-pitched voice might convey that you are upset so speak with a lower tone when possible
  • Speak clearly and directly (and, to repeat, slowly)
  • Don’t correct your loved one
  • Ask things nicely: Don’t make demands
  • If you feel your words becoming heated, stop. Take a deep breath. Try again later
  • Don’t take adverse behavior personally.
  • Respect the person as an adult; don’t talk down to him or her
  • If he or she cannot find or make the words, gently finish a sentence as needed.
  • When at all possible, allow choices — such as “Should we pay the gas bill or electric bill first?” or “Would you like tea or coffee?” etc.
  • Frequently praise your loved one and spread affirmation — for even the smallest things. Make phrases like these a frequent part of your vocabulary: “Thank you,” “Good job!” and “You’re the best!”
For more information, be sure to downloard the Indispensable Alzheimer’s Resource Kit which is available at no cost to you simply by clicking here.
       
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Besides medication, how can one deal with agitation?

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February 10, 2012

- Alzheimer's Care, Blog, Elder Law Articles

First, it’s important to be on common terms when discussing any word, concept or issue. This holds true for agitation. Many of us have experienced agitation at some point in our lives. When we get so emotionally overwhelmed, it leads to unrest. Let’s look at the meaning of agitation, as cited in several authoritative resources:

* “Extreme emotional disturbance.” (The American Heritage Dictionary of the English Language)

* “A mental state of extreme emotional disturbance, the feeling of being agitated; not calm.” (WorldNet 1.6)

* A stirring up or arousing; disturbance of tranquility; disturbance of mind that shows itself by physical excitement.” (Webster’s Revised Unabridged Dictionary)

Most people can identify such a feeling in themselves and use appropriate coping mechanisms. But this can be impossible for people with Alzheimer’s disease. Often, they are unable to get in touch with, or express, their feelings. When they experience agitation, therefore, it is hard for those around them — caregivers, family members and others — to understand or offer help. We won’t go in-depth into it here, but the issue of medication should be mentioned. Medication could be responsible for sudden changes in mood or behavior, and that includes agitation. A new medication or a changed dose might be the source of new levels of agitation. Keep notes and discuss them with your physician. Do not think you have to wait for your next appointment, which could be weeks or months away. Call right away for assistance. Realize that both prescription and over-the-counter medications can be responsible for heightened levels of agitation. Always consult a doctor before starting, stopping or changing any medication.
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I want to better understand my loved one’s agitation but don’t know how

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February 9, 2012

- Alzheimer's Care, Blog, Elder Law Articles

We must make an effort to try to determine what a person with dementia is trying to communicate when he or she displays agitation or other “symptoms.” Many professionals who work with dementia patients think that there is a cause of reason to every behavior. “If we spent as much time trying to understand behavior as we spend trying to manage and control it we might discover what lies behind it is a genuine attempt to communicate,” is how Malcolm Goldsmith of the UK Journal of Dementia Care put it. People with dementia must continue to be viewed as individuals — as people who continue to need to be heard and have feelings. Whoever we are, often we find the source of anger or agitation stems simply from not being heard. Everyone needs to have his or her feelings validated and/or understood. Insensitive or uncaring responses can alienate or agitate anyone. If, for example, a trusted friend is told about a sensitive issue that made you cry and responds with, “Why should that make you cry?” you will not feel as if you’re being truly heard. Your feelings certainly won’t feel validated. A better response from your friend would be something like, “I’m sorry you’re upset. Would you like to talk more about the situation?” Even though your friend’s feelings might differ from yours  — you might not become upset about the same things — she can still validate you. Take another example of validation, using an upset child. The child might tell his parents that he is being picked on at school. If the parents shrug it off or treats the subject too lightly, the child won’t feel as if he’s been heard, understood or validated. However, if a parent responds with, “That really upsets me, too” and asks to talk the problem out so “we” can make things feel better, the child’s feelings will be validated. The end result is the child will feel better about himself. This is critical. A parent might not view the situation at school with the same alarm or concern as the child, but that doesn’t change the importance to the child. It’s very important to remember that, in order to determine if the issue needs to be address, we must LISTEN. This is no less true with a person with dementia. He or she needs to be heard and genuinely validated, just like anyone else. His or her experience might not seem like such a big deal to us, but it might be to him or her. That is a critical aspect to remember. Many every day tasks can become difficult or overwhelming to people with dementia. They can start to feel unsure, inadequate, and even fearful as anxiety builds. Such people need to feel supported and the love that any of us need to get through difficult days. Be generous with lines such as: “You did a good job,” “Thank you for your help!” “You are a wonderful person” “You are in a safe place,” and “I love you.” Affirming statements such as these can boost self-esteem and give a person validation. What you say to them might quickly be forgotten, but the good feeling may last. Validate feelings, affirm often and genuinely listen.
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If I’m suspicious, should I have my loved one evaluated for Alzheimer’s risk? By whom?

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February 8, 2012

- Alzheimer's Care, Blog

The quick answer: yes. A doctor must be consulted for a full evaluation as soon as you notice the first symptoms of dementia —more than just mild forgetfulness or confusion. This type of professional check-up will help determine why the symptoms are present. Are they due to depression? Poor nutrition? Drug use or alcohol abuse? Organ dysfunction?  If your loved one has never been evaluated for dementia before, your best bet is to consult a neurologist or geriatrician. For those who have been diagnosed with Alzheimer’s, a geriatric psychiatrist should be contacted for signs of anxiety, depression, agitation or any other behavioral issues. You must be comfortable with any physician you use, especially since you’ll likely get into very personal lines of questioning. Remember: Everyone is different, so a doctor who might be appropriate for a friend might not work for you. That is OK and you should keep looking if you’re not satisfied. Doctor referral services can provide a list of appropriate physicians. It is often comforting to know you are using a doctor whom others have used and liked. Caregivers also might receive information and referrals at support group meetings so look into those, too. The reason it’s so important to get an early diagnosis of dementia is it can make treatment easier and more effective for all involved. Most importantly, it can lead to appropriate medication that might help slow the progression of the disease. An initial, thorough check-up should include a physical examination, medical history, neurological tests, laboratory tests, brain imaging and function tests. An individual diagnosed with dementia will see a geriatrician, neurologist or psychiatrist for any issues directly related to the dementia. But a patient should inform his or her primary care physician of the diagnosis, and continue with the doctor for general check-ups. Experts agree the best proactive strategy to achieve successful caregiving at home is to have a healthy caregiver. Alzheimer’s truly is a family illness. A doctor needs to be aware of the caregiver’s stress level and be willing to offer support, suggestions and encouragement. The best doctors in this field will be concerned about the health and well-being of the caregiver.  
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Where can I find information about Pick’s disease? What kind of support is available?

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February 6, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Many other conditions and illnesses have deeper support networks and more easily attainable information than Pick’s disease. But help is out there, and you can do certain things to help you or your loved one, regardless. Pick’s disease is a form of dementia manifested by a slowly progressive deterioration of social skills and changes in personality, accompanied by impaired intellect, memory and language, according to the National Institute of Neurological Disorders and Stroke (NINDS). The disease varies in how it affects individuals, but there are some common symptoms that can appear at various stages of the disease. These include difficulty thinking, loss of memory, emotional dullness, lack of spontaneity, loss of moral judgment and progressive dementia. The range of onset can be from 20 to 80 years of age, though it most often affects people 40 to 60. The cause of the disease is not known, though researchers have discovered that patients typically have atrophy of the frontal and temporal lobes of the brain. Some nerve cells have characteristic abnormalities when viewed under a microscope at autopsy. There is no known cure for Pick’s but certain symptoms can be treated. Along with NINDS, the National Institute on Aging (NIA)performs research on Pick’s. A fantastic online Pick’s disease support group is based in the United Kingdom and can be found here.  You also can contact the Alzheimer’s Association or your local area Agency on Aging to inquire about support groups in your area. If there isn’t one available, be proactive and contact a local social service agency to start one. Receiving support from others, and giving it back to others in your situation, is invaluable.
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I have a brother with Down’s syndrome who also has recently been diagnosed with Alzheimer’s disease. What should I expect about behavior changes?

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February 2, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Because individuals with Down’s syndrome are living longer than ever (in general), more are experiencing the onset of dementia. This can be very difficult for everyone to accept, especially if your brother was high-functioning. Odds are your family has become accustomed to having your brother take an active part as a family member. It’s not uncommon for those with Down’s to live at home with other family members into their adult years. But when the dementia sets in, behavior will indeed change. There’s no way around it. One of the changes will be memory loss, another possibly losing the ability to perform even the simplest activities of daily living. Dressing, exercising, even setting the table or generally helping out around the house might be lost skills. As a result, your brother might begin to withdraw and not want to leave the house due to feelings of insecurity and fear of suddenly unfamiliar routines and surroundings. A routine is critical for maintaining self-esteem. Always allow your brother to help at whatever the appropriate levels are to boost his self-worth. Provide a failure-free environment, to the degree you can. Make sure family members are on board with this, and have everyone compensate for your brother’s lost duties. [Note that it’s possible you could forget or temporarily not realize your brother is functioning at a different level. While physical disabilities are typically obvious, Alzheimer’s disease involves the brain, leaving the patient to look quite the same on the outside. You might expect him to be just like he was. This is not realistic. Go with the flow and let him be himself, at whatever stage he is.] As the sibling of an Alzheimer’s patient, you must allow yourself to grieve. You have lost a person you once knew at a higher level of functioning, and you will continue to lose him more as time goes on. Feelings of shock, denial, anger, isolation, fear and depression can be expected on your part. Write them down in a journal. Realize you will go through these stages. The final one will be acceptance. You need to get there — for your sake and your brother’s. But even when you get to acceptance, you will continue to grieve at times, and that is normal. How can you help yourself cope? Gather photos of your brother, you and your family. Look at them. We are given the gift of memory so that we can go back to when times were good, or at least better. This can be a painful activity, but through the pain you can find healing. Life will be different when an Alzheimer’s diagnosis is added to Down’s syndrome conditions. Lower your expectations. Let your brother do what he can, at the levels he can. If you go into, and remain in, denial, you will push for things that your brother is not capable of accomplishing. Then, you will both become frustrated. Accept him for who he is, where he is. Let him assist with activities that he will feel successful doing. Always find the appropriate level. This may be a continually sliding bar. Constantly assess — activities may be the same kind as before, but just at a different level of expectation — and modify your actions accordingly. A good, free reference source for any family member of someone diagnosed with Alzheimer’s is “The Indispensable Alzheimer’s Resource Kit.” Click here to check it out.    
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Could the Draconian New Medicaid Rules for Long-Term Care in Illinois (effective Jan. 1, 2012) Really Be A Cloud With A Silver Lining?

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February 1, 2012

- Alzheimer's Care, Elder Law Articles, Medicaid and Paying for Nursing Home Care

New Rules As you may have read in recent columns, Illinois has adopted new rules for Medicaid coverage for long-term care for our citizens and the state of Illinois (“DRA”). These new rules took effect January 1, 2012.  The new rules are going to require that our clients engage in what we call “Five-Year Planning.” This “Five-Year Planning” has become  necessary because of the fact that there will be a new five-year lookback for all Medicaid applicants when there are asset transfers that take place after January 1, 2012. The Silver Lining What may come as a surprise to many of our clients is that the unintended consequences of these rules may be that long-term care planning for our clients may actually be enhanced in some ways. The silver lining in all of this is that while the lookback period and the need to plan further in advance is one of the negative aspects of the new law, the need to use trusts of a very specialized type in order to comply with the five-year look back may actually provide some very positive consequences. How to take advantage of the New Rule Following is an example of how the new rules could work in your favor.  Instead of leaving assets for their children outright, parents can now consider leaving assets in trust for their children. Leaving assets in trust for children carries with it the following benefits:
  1. the ability to protect the assets inherited by a child from the creditors and predators of the child, such as divorcing spouses, business creditors, tort creditors, etc.;
  2. the ability to allow the management of the assets to continue under the supervision of the parents’ financial advisor who may have assisted the parents over the years in accumulating a critical mass of assets that can provide for many years of security for the children;
  3. the ability to meet the five-year lookback requirement of the new Medicaid laws;
  4. and, finally, the ability to prevent the children from squandering or losing the assets that the parents carefully accumulated during their lifetime.
We are currently experiencing the greatest intergenerational transfer of wealth in the history of the world. However, there are often problems with transfers of wealth. Quite often, the parents pass away and the baby boomer generation will take funds in what used to be a well-managed and profitable brokerage account, and the money is randomly moved or, worse yet, squandered shortly after it is received. So I often ask both our clients and their financial advisors if they would  be interested in establishing a systematic relationship for the management of assets so that a client’s family can continue to retain the benefit from financial management even after parents pass away? The recent adoption by the state of Illinois of the DRA will provide an entrée and solution to this problem for all. In the past, this was sometimes difficult to do. The opportunity to avoid the unintended squandering and loss of assets at the death of the parents now exists with the increased usage and importance of so called Five- Year Planning as part of our “senior” estate planning process.  This planning always existed, but is now more critical than ever, with the passage of DRA in Illinois and the required “5 year or 60 month lookback period.” My preference is to work with clients and their advisors  who appreciate the wisdom of keeping client assets protected from creditors and under  management of the financial advisor. Call To Action If this interests you, then please call my office so that we can schedule a time to meet and I can discuss this new law with you. I think you’ll be amazed at the opportunities that the law presents to the older generation, as well as to the younger generation. You have our best wishes for the new year! I hope to speak with you soon.
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Why am I so angry that my mother has been diagnosed with Alzheimer’s disease?

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February 1, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Uncategorized

You are going through a grieving process when you are in a situation like this. A normal, regular stage of grief is anger. The key is to not let it overtake you or cause declines in your own physical or mental health. Grieving has several stages. Just like individuals experience Alzheimer’s in different ways, at different speeds, the same is true with grief. Some stages might be quicker than others, and some might not materialize at all. Be patient with the grieving process. Allow yourself to feel, allow grieving to run its course. When Alzheimer’s is involved, the 10 normal stages of grief are as follows: (REMEMBER: You might or might not experience all of these, and even then, to varying degrees.) Shock: Disbelief that Alzheimer’s has been diagnosed. Denial: It’s not really Alzheimer’s. It’s just a stage that will pass. Depression: Feelings of loneliness and isolation take over. Physical symptoms of distress: Sickness and tiredness consume you or your thoughts. Anxiety: What will the future hold? What might happen to me? And other worries. Anger: Everyone’s fair game: Anger at the disease, the doctor, your loved one, even at God for “allowing” this to happen. Guilt: Blaming ourselves — often for things we have/had no control over, or for doing things we think we shouldn’t have done, such as yelling. Hesitancy to keep up normal activities: Worries about how others will view or treat you and/or your loved one. Healing of memories: Realize that painful memories are actually part of the healing process. Acceptance: Coming to grips with the fact that your loved one has Alzheimer’s, it is here to stay and you simply have to make the best of it. Alzheimer’s is tough on the psyche. Because your loved one can go through several stages of the disease, you might experience stages of grief (as described above) with each one. Realize that this is normal. Allow grieving to take place. Let yourself be angry. Keep a journal with your feelings and thoughts. This is often a healthy way to express yourself. It allows you to vent, without hurting your loved one or anyone else around you. If you can deal with your feelings in this manner, you will be in better shape to help your loved one — and conduct your life as you need to. If you become dispirited and internalize your distress, it can damage you not only mentally or emotionally, but physically as well. That is not going to help you be there for your loved one’s needs. Here is something that will help you deal with your feelings: “The Indispensable Alzheimer’s Resource Kit.” These FREE books will help you deal with your feelings, as well as with dozens of other subtopics.
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