How aggressive should we be with treatment for recurring colon cancer if my father also has Alzheimer’s?

March 1, 2012

- Alzheimer's Care, Blog, Elder Law Articles

A family meeting with the oncologist to learn about the cancer would help all of you get on the same page. This is a very difficult situation. The oncologist can answer your specific questions about the nature of the cancer, treatment options, prognosis, etc. You most likely won’t want to be too invasive or aggressive with the cancer treatment. Confusion will increase with any type of operation or aggressive treatment. Be sure you know the risks involved if surgery is deemed necessary. As part of this scenario, your physician can order hospice care. Hospice services not only help the loved one but also the family as a whole. Hospice specialists will take the Alzheimer’s into consideration, too. Hospice is a wonderful form of care that provides education, support and care. The goal of hospice is to make it possible for your loved one to stay in his or her own home, out of the hospital, and also to make it as comfortable and pain-free as possible. The overall goal is to create the best quality of life possible. One of the best things about hospice is the fact that it helps not only the patient but family members as well. For further information, please access our FREE “Indispensable Alzheimer’s Resource Kit” by clicking here.

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Should you tell someone with Alzheimer’s that a close friend has died?

By Anthony Ferraro on

February 29, 2012

- Alzheimer's Care, Blog, Elder Law Articles

This has been the subject of open debate for a while. The short answer is: It really depends on the person. If it’s your loved one involved, you know him or her better than anyone. If you think he or she can handle it, then the answer is you probably should share news of the friend’s death. Important considerations include thinking how the news will affect your loved one and whether there will be any benefit to it. You also have to consider how well your loved handles stressful situations. If the deceased is someone your loved one has seen regularly, then it might be best to share the news. After that, you are still likely to be asked about the person’s whereabouts, due to short-term memory loss. Then, you have to ask yourself if it’s worth it to keep repeating news of the death or if it’s time to exercise the right to use “therapeutic fibs.” These are always used to protect the person with dementia. See how it goes after you tell your loved one about the death and take it from there. If questions persist about the deceased, you can (honestly) say that the person just “isn’t here right now.” Or you can say in an assuring tone that although you’re not sure where the person is, you are sure he or she is OK and in a safe place. Whether or not to talk about a death also depends on how far Alzheimer’s has progressed. With later stage dementia, it probably isn’t beneficial. Regardless of the stage, if your loved one wasn’t particularly close to or frequently around the deceased, it might not be to your benefit to raise the subject. The same thought process comes into play if your loved one inquires about his or her parents. Even if the parents have died long ago, your loved one’s long-term memory might be kicking in, bringing them more prominently to mind. Validation is the best strategy to use when this happens. Say, “I know your parents aren’t here now and you miss them, but they are OK and they know where you are.” Then, you can reminisce. For more information about communicating with a loved one with dementia, please click here to listen to a Jo Huey speak on this very delicate subject. It is a very informative discussion available free as an mp3.

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Does Alzheimer’s disease ever bring positive personality changes?

By Anthony Ferraro on

February 27, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Yes, it can — but probably not the way you think, or may be hoping for. What Alzheimer’s can do is essentially erase bad behaviors or attitudes, which fall by the wayside as memory and decision-making abilities fade. When something like alcoholism, bipolar disorder or schizophrenia is present before the onset of Alzheimer’s, it “goes away” as the disease progresses. This has led some people who have loved ones with Alzheimer’s to say dementia or Alzheimer’s has “blessed” the person. If the victim was abusive or harsh beforehand, he or she might become happy, loving and docile afterward. Sometimes the families can joke about having a support group for people who are happy about Alzheimer’s. One man had an alcoholic wife for most of their 50 years together. This included the rearing of six children. As Alzheimer’s symptoms started to take more and more control of her mind, she forgot to drink and became more loving and soft-spoken. It was as if the dementia had brought out the best of her. She showed sides of herself that close friends and relatives had not seen in many years. Her children liked visiting, and she was kind to them. She also showed a good sense of humor. Often, her husband said those years were some of the happiest times of their married lives. In some ways, he was grateful for the dementia that claimed his wife’s mind. He went as far as to suggest that the disease had given him and his wife a second chance to live together happily. She stayed in their home, and he was her primary caregiver until her death. Alzheimer’s is a tragic disease, but sometimes it brings blessings. For more information, check out our Indispensable Alzheimer’s Resource Guide which is available FREE online by clicking here

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Having heard a lot about agitation, I’d like any extra advice I can get

By Anthony Ferraro on

February 22, 2012

- Alzheimer's Care, Blog, Elder Law Articles

“Love cures people. Both the ones who give it and the ones who receive it.”

— Karl Menninger

The above is a good quote to keep in mind. Dealing with agitation and/or dementia can be a marathon struggle. Choose your battles wisely and know that just because a person’s behavior might be bothersome to you, that does not mean it is an issue for a person with dementia. If you’re stressed about a loved one’s behavior, first ask yourself: Is this person in danger? Is anything detrimental to his or her health? Do I really have to do anything? Or might I be making a mountain out of a molehill? Here’s a good example: Your loved one is getting dressed — with multiple layers of clothing. This is a change from pre-dementia days. Before worrying, getting angry or trying to change anything, ask yourself: “Is it really hurting anyone?” If the answer is “no,” then let it go. Confronting someone with dementia about this and making him or her change clothes, could produce agitation, and possibly an angry outburst. Remember: Your goal in this type of situation is to prevent or divert any stimulus that could bring on agitation. As typical adults, we don’t like being told what to do. A person with dementia is no different in this regard. Being able to “go with the flow” on your part will go a long way; concentrate more on the issues that are truly serious enough to address. If you can do this, you and your loved one’s lives will be much less stressful. We must constantly remember an underlying premise: People with dementia always need to feel loved, useful and needed. We must help create an environment that shows them love. We also must allow them to help as much as they want, and in so doing set them up for success. A big tenet of this is coming to grips with “behavior acceptance.” As caregivers and loved ones, we have to realize unwanted behavior is part of the disease process and that there is a reason for it. When we think this way, we can respond more effectively to situations where agitation is present, as well as others that need attention. What are some strategies for doing this? For example, instead of putting someone on the defensive with something like: “Your clothes are dirty. Would you please change into something clean?” You could phrase it this way: “Let’s go change our clothes so we an go to the store.” This directs action but it is less demanding of the person with dementia. By involving yourself, it comes off as less threatening. Use this line of thought, if it will help: “We cannot control what comes our way, but we can control how we respond.” If our thought preparation is, “How can I best respond to this situation or behavior?” it averts putting the onus on your loved one as “the problem.” The person with dementia is not able to change, so we have to.

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What can I do to my mother’s environment to lessen her agitation?

By Anthony Ferraro on

February 21, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Human behavior is greatly affected by one’s environment. Therefore, you must pay special notice to what goes on in the surroundings of a person who has dementia. That person is liable to have heightened chances of feeling fear or insecurity so he or she needs to feel safe to minimize them. Because there are so many environmental aspects that can cause worsened confusion or agitation, a continual assessment of the overall environment can help prevent agitation. A few examples of potential trouble areas include:

Temperature (too hot or too cold)
Noise (too loud or too much
Lighting (too bright or too dim)
Walkways/hallways (too cluttered)
People (whether they’re comfortable around them)

Look for patterns associated with typical sources of agitation, including: bathing, activities or events such as children visiting, and time of day. Address the specific issue as soon as you denote a pattern. It might mean changing visiting or showering times. While these issues might seem relatively insignificant to you or most people, they can be a HUGE issue to your loved one. Therefore, try to set up environments that are laid back and can help ease agitation. What is best? Whatever works for your loved one. Some examples of calming effects are:

Playing a favorite kind of video or music
Sititng in front of a fireplace
White noise, such as a fan or other motor hum
Getting fresh outside air
Burning fragrant candles or incense
Bird watching
Anything else that is known to decrease agitation for your loved one

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What are the effects of pain on agitation?

By Anthony Ferraro on

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

By Anthony Ferraro on

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?

By Anthony Ferraro on

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?

By Anthony Ferraro on

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

By Anthony Ferraro on

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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