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My mother refuses to take a tub bath — something she always loved. What can I do?

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April 9, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Hygiene is often a concern as Alzheimer’s progresses. Reluctance to get into a bathtub often has to do with safety concerns for the individual involved so realize what you’re up against. A fear of falling might make her fearful about climbing into the bath. She also might be worried about the water being too cold or too hot, so make sure the temperature is suitable and THEN try to get her into the bath. Difficulty dealing with spatial relationships also can be a challenge with Alzheimer’s patients. When walking, they might not realize a black line or patch on a carpet is not a hole they can fall into. While bathing, they might not be able to discern where the water line is. Adding a few drops of food coloring to the water or using bubble bath can help ease concerns or help your mother discern where the water begins. Another possible idea is to put a brightly colored bath mat on the bottom of the tub. Your mother needs contrast to help determine where the tub begins and ends and where the water begins. Frequently one of these tips or some other modification you discover will lead your mother to start enjoying baths again.  For more information, an excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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My mother has Alzheimer’s and won’t shower any more. How do I keep her clean?

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April 6, 2012

- Alzheimer's Care, Blog, Elder Law Articles

People with dementia typically are reluctant, if not downright fearful, of bathing. This is not uncommon. Take into consideration how she has always bathed and use that as a template for how to proceed. Trying to adhere to the same schedule, rituals and routine will be helpful. If she always has bathed in the morning, keep with that. If she bathed four times a week or daily, stick to that. This is such a challenging issue, quite often family members will hire a bathing aide. Home care agencies can help you find someone if you don’t have someone on your own. It can be a win-win, as quite often the person with dementia will react better to someone outside the family, especially when it comes to something so potentially uncomfortable or embarrassing like bathing. Here are some suggestions for addressing the challenge of bathing someone with dementia: • Let the shower warm up the bathroom for a while before getting under way. Taking off clothes in a cold room is uncomfortable. • Play soft, soothing music. • Ensure good lighting in the bathroom. Fear increases when a person can’t see well. • Use a shower chair so the person can feel steady and comfortable. These can be obtained at medical supply stores or certain pharmacies. • Use a handheld showerhead or wand. This makes the situation less threatening, and it’s less likely to cause anxiety from water beating down on the person. • Use a type of soap she has always preferred. It will help if she recognizes a favorable fragrance. • See if she can bathe herself at all — then let her do it, giving her as much privacy as possible. • If you have a bathtub and she’s mobile enough, try to let her soak in it. This can be soothing, and it also allows cleaning of areas that might be difficult to get to with a shower. • Sponge baths are a good option between “regular” baths. Hospitals and nursing home regularly conduct bed baths, so there is plenty of precedence for it. The market has responded with various products that can help, such as dry shampoo. For more information, an excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.    
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What do I do if my dad, who has Alzheimer’s, decides to “call it quits”?

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April 5, 2012

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

This is a good question for Alzheimer’s patient caregivers since it’s not an uncommon scenario. At some point, you dad may decide he’s ready for death. This could be verbal, but if he can’t talk, you still might be able to sense it. By this point, no doubt, the disease will have been a tough battle. He could be very tired. As hard as it might be for you or other family members, you have to let go and allow your father his wish, and the peace he is seeking. Death is, after all, a part of life. For him, death is a good thing. For those left behind, it can be difficult. It is never easy, no matter how long the disease has been around or how much you’ve prepared for a final good-bye. By this time, you will already have lost a lot of your father along the way, yet it is tough to come to grips with because it is so final. Let yourself grieve. Talk with others around you — friends, family, professional counselors, clergy, etc. Continue to speak with your father. Reminisce together. Sharing your feelings and thoughts can be a healing process. Of course, contact your father’s physician if you sense he is ready to die. The doctor might order hospice care. It is a wonderful service that will not only help your father but also you and the rest of the family. Hospice workers’ goal is to make your father comfortable, peaceful and pain-free. They also want to support you in your time of grief and lighten your load. They will allow you to rest and recoup energy. Hospice is there to help the entire family in the grieving process.  An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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I moved my father with Alzheimer’s from out of state to be near me. Any suggestions on how to help him adjust to a new area?

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April 4, 2012

- Alzheimer's Care, Blog, Elder Law Articles

First of all, give it time. Your father might need a week, or months, to adjust. He’ll also need to be able to let out any concerns and other feelings. His concerns need to be answered and his feelings validated. Grief likely will be among the feelings. After losing his job, his wife and now his long-time home, he is losing a part of himself each day, too. You’ll find out — if you haven’t already — that many times it’s a dead-end street when you try to reason with someone with Alzheimer’s. Your father could become more confused and unsettled if you try to explain in detail why you had to move him. When he asks about the situation, you can tell him, “I know how hard this move has been for you, but I love you so much, I wanted to be nearby and have you close to me.” Here are some other things you can do to help him adjust:
  • Make a photo album of things that bring up good memories so he can review it over and over. Include pictures of family members, friends, the house, and favorite vacations and accomplishments. He can look to his heart’s content, several times a day, if he wants. When he’s feeling stressed or said, this should have a calming effect on him.
  • Make sure there are personal items he can recognize in his room.
  • Ensure that he knows his friends and neighborhood. Make introductions as necessary.
  • Let him write a journal, in which he can record his feelings at least once a day. (This could require extra help from you, the caregiver.)
  • Find a local support group near your house that he can attend. Call the Alzheimer’s Association for recommendations.
  • Have him talk with various people (not just you). Whether it’s a professional counselor, a priest, a friend or someone else, it will help immensely.
Remember: Your father will need a lot of time and attention. Give them. Constantly reassure him and affirm his presence. Repeat that he is in a safe place, that you love him and that you will continue to make good, healthy decisions for him, based on his wants and needs. Tell him often how well he is doing. Thank him profusely for whatever he helps with. Include him in as much decision-making as possible and ask him for input at a level he can handle. If you do all of this, things still might be difficult, but you will be doing the best that you both can. And who knows, he might surprise everyone and adjust with little difficult.  An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.  
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What can we do for my mother, who used to love to read but now doesn’t?

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March 30, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Try giving her short stories or magazines if the issue has become that books are now too long. You also can involve shorter bits of reading activities, such as asking her to read parts of recipes while you’re cooking. She’ll feel good about helping, too. Of course, there are audio books, which you can check out from your local library. You can choose from all kinds of books and other printed material. In some places, you can actually check out a tape player or other equipment to take home for as long as it might help your mother. Some of the tape players are extremely user friendly; many are intended for use by people who are blind or have other disabilities. Sometimes, headsets are available. This helps allow listening in many places — and without disturbing others. Just pay close attention to the volume. If it becomes too loud, this can cause overstimulation, which might then produce agitation, anxiety or wandering. You can check out all kinds of books — inspirational, funny, upbeat, etc. Many libraries also have reading programs. Perhaps a friend or family member can take her to one of these, making a “trip” of it, if she’s up to it. Seniors centers also offer many adult activities. Adult day care centers are another option in many areas. This can be for most of the day or for just a fixed amount of time. If your mother can still read but doesn’t comprehend, she could read to other individuals, thereby feeling helpful and building some self-esteem. Many times, seniors centers have story times, when she could either read, or be read to. You also can seek out volunteers — such as girls or boys, neighbors, church members, relatives or members of a service organization — who can read to her at her home. These are great service projects for students, who nowadays often need service hours in order to graduate. There are many people who might be willing to help: They just need to be asked. Also, reading together could be some of the best quality time you spend with a loved one. But if you’re not able to do this, don’t feel guilty. Find someone else to do it in your place. There is no doubt, however, that if you’re looking for something to do with your mother, reading to her could be a big help for both of you. Even if she does not totally understand what’s being read, she will be experiencing an activity that she has always loved, and that will feel good to her.    
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My father thinks people and events on TV are real and he often wants to interact with them? What should I do?

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March 29, 2012

- Alzheimer's Care, Blog, Elder Law Articles

There have been people with Alzheimer’s who have refused to do something until getting an answer from a TV character; others have thought music shows are actual concerts. This has worried family members, who have wondered whether they should cut off TV watching altogether for their loved one. But you have to think it over: Is this causing any harm? This is not an uncommon behavior for someone with Alzheimer’s. You have to weigh what the TV situations might be doing to your loved one. Does watching TV become distressing, or are the characters and stories seen as friendly? Often, it’s the latter, and you can never have too many friends! If TV scenarios and people become threatening to your father, then you must limit how much TV he watches. If there is a TV in his room, you can remove it. Odds are, it isn’t doing much good for him if stress is involved. If or when he sees other residents watching TV, his attention can be redirected toward other activities. If he’s not living at home, talk with the staff at his care facility and let them know of your concerns. Tell them you would like to have his TV time limited. They can help redirect him toward bingo or other activities instead. If there winds up being no TV in his room, ask staff members to take him to one of the facility’s common areas to watch a favorite show(s) there. If there is a VCR or DVD player, you can bring programming that you have purchased or rented so he can view it.    
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What kind of support is there for a person with Alzheimer’s?

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March 22, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Head to www.alzhope.com. That’s where people with Alzheimer’s can become part of a loving community, can post questions to others caring for their loved ones with Alzheimer’s and more. Another good place is the Alzheimer’s Association’s website (www.alz.org). It has a list of programs offered, including for supporting individuals diagnosed with Alzheimer’s. Link from this nationally focused website to the appropriate local association. That will get the person resources closer to home. Perhaps the most common support is an early-stage support group. These are sponsored by the Alzheimer’s Association and are spreading around the country. These are primarily for the support of individuals who have just learned of their Alzheimer’s diagnosis. An experienced facilitator guides the group in discussions about issues such as the meaning of the diagnosis, family dynamics and emotional issues, and financial and legal concerns. This is a place to express one’s deepest feelings in a safe place — with people who will identify and understand. These groups laugh, cry, eat and problem-solve together. The groups meet once a month on average, typically for about an hour and a half. Someone from the Alzheimer’s Association will be able to judge individuals to determine whether the meetings would be a benefit to them. Meanwhile, family members have simultaneous meetings in their own special area (often in the same building). Professional counselors, members of the clergy and home health agencies also are options for individuals’ support. You also can get in touch with the Alzheimer’s Disease Education & Referral Center (ADEAR) at (800) 438-4380 or www.nia.nih.gov/alzheimer’s, or the National Institute on Aging/Alzheimer’s Disease Information at www.nia.nih.gov or (800) 222-2225.
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My mom has Alzheimer’s and continually says things like, “I wish I were dead.” What should I do?

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March 21, 2012

- Alzheimer's Care, Blog, Elder Law Articles

There are a few possibilities for this. Your mother could be dealing with depression, or it could be her way of expressing her frustration about the disease. Regardless, she needs to be observed and monitored. A physician can examine her and prescribe an antidepressant if he thinks it’s warranted. So do call a doctor if you think it’s depression-related. Your mother needs assurance about her changing condition. Inquire regularly about how she is feeling and discuss things — not just Alzheimer’s. It is OK to talk until she gets in touch with feelings she might have such as frustration, anger or fear. This is where validation comes into play yet again: It is essential. Say things such as, “I know you’re not feeling yourself lately, but you are so wonderful, Mom. That hasn’t changed.” Or maybe, “Mom, please tell me what you are feeling that makes you want to die.” Odds are she will talk about how inadequate she feels. Constantly reassure her, tell her she is loved and needed. Then go another step and give her opportunities to help so she feels she has something to contribute to the family. All human beings need to feel they are contributing. When Alzheimer’s or dementia hits, however, it’s easy for a person to feel he or she has nothing to offer. That’s where loved ones must see to it that this individual is given an environment where he or she can feel needed and useful. Provide opportunities to help with chores around the house. No matter what the activity is, modify it as needed in order to make the person feel useful. It makes no sense to start a chore set that is too difficult, or start appropriately and then not simplify as needed. For example, if laundry were the focal point, your loved one might be able to start with gathering, loading/unloading and folding the clothes. Also measuring soap, setting the dials, drying and folding could be included. But then, as the disease progresses, tasks might need to be peeled off or scaled back. This still allows your loved one can keep his or her “laundry” duties and identity. For additional information, get our FREE “Indispensible Alzheimer’s Resources Kit” by clicking here.
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Haldol as a medication for Alzheimer’s has me worried. Is it safe for my mother?

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March 15, 2012

- Alzheimer's Care, Elder Law Articles

One of the first psychotropic drugs introduced to the market was Haldol. Its goal was to subdue young and healthy — but violent — psychiatric patients. It is a successful drug when used for the appropriate purpose and at the appropriate levels.  But when used on elderly or Alzheimer’s patients, many questions seem to arise. Can it create confusion? Can something else be given for agitation with better results and fewer side effects? How long does it take for Haldol to leave the system once it is subbed out? And the list goes on.  Medications affect people differently. What works for one individual might not for another. To some degree, prescribers will tell you, it becomes a guessing game. All medications have side effects. Some people will feel them differently, or not at all. There might be, for example, a medication to treat anxiety that … creates anxiety. This type of reaction may be fairly common among older individuals. If taken for a long time, Haldol (Haloperidol) can create many side effects. (Typically, it is prescribed for people who hallucinate and/or act aggressively.) Ask your doctor to try other prescriptions to see if they work reasonably well as an alternative.   Keep in mind that some individuals tolerate Haldol well. Regardless, it builds up in the body, so complete removal from body systems might take a few weeks, depending on how long a person was already taking it.   To allay your concerns, the best strategy is to talk with your mother’s doctor. Tell him what your observations are and ask what the options are. There are numerous medications out there created to treat these same conditions.   As always, if you aren’t satisfied with the response you get from one physician, consult another. Geriatric psychologists and neurologists are usually on top of the latest and most effective medications available. As an aside, older patients are usually started at the lowest doses possible and then inched up as needed.   Another route you can take is to have your mother admitted to a gero-psychiatric unit. These are specialized places for observation of behavior and monitoring or adjusting medications specifically for elderly patients. Doctors get a much more complete picture than usual thanks to 24-hour observation and monitoring over several days.   Dealing with a loved one with Alzheimer’s is a daunting task. There’s no need to tackle it alone, however. An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.    
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My spouse has Alzheimer’s and isn’t sleeping at night. What should I do?

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March 14, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Sleeplessness or insomnia can be a common Alzheimer’s issue, though not everyone experiences it. If your loved one does, here are some helpful tips: 
  • Keep your physician informed so he or she can intervene, if needed (this might be a condition you monitor for a while)
  • Ask the doctor about medications that might be interfering with sleep
  • Limit caffeine and alcohol intake
  • Discourage naps during the day
  • Plan relaxing, soothing activities for close to bedtime (play calming music, for example). This could involve having a light snack.
  • Make sure your loved one goes to the bathroom before bedtime
  • Keep to a routine at bedtime, yet, as always, you have to remain flexible
  • Use a favorite pillow or blanket to help relaxation efforts
  • Do bathing or any other activity that could be upsetting earlier in the day: Steer clear of anything that could create tension or be upsetting near bedtime
  • Don’t make bedtime too early
  • Keep the person as active as possible during the day. Walking, working in the yard, dancing or any other activity he or she likes to do can be helpful.
  • Ensure comfortable clothing and temperature are in play at bedtime. If putting on sleepwear agitates your spouse, let it go and let her or him sleep in regular clothes.
  • If your loved one falls asleep on the couch, let her or him stay and sleep there.
  • Use night lights liberally in the bedroom, hallways and bathrooms.
Dealing with a loved one with Alzheimer’s is a daunting task. There’s no need to tackle it alone, however. An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.    
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