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What should I tell my grandchildren about Alzheimer’s disease?

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May 18, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Children handle these types of things differently and can have widely varying reactions, depending on their age, upbringing and personality. They also will devise different ways of coping. But no matter what the age, be honest with them — at a level they can comprehend. Then let your grandchildren talk openly about their feelings. Having someone you know and love with dementia causes grief — in all age groups. A part of a person you love is vanishing and changing each day so it is natural for someone close (of any age) to experience the grief process kicking in. If you are not comfortable with talking with them about Alzheimer’s or letting them know about a new diagnosis, have someone they trust speak with them about it. This might involve using the services of a licensed counselor or a support group, depending on the circumstances. This is a stressful family dynamic and must be handled with care. Everyone is experiencing grief, anxiety, loss, change and, eventually, death. The national office of the Alzheimer’s Association has excellent information for children on its website. Visit it here. There are also many fine books available on this subject. You can find various titles available for everyone from young children to adolescents. They also can be found at the Alzheimer’s Association website Many online book sources. Suitable publications also can be obtained from the American Health Assistance Foundation.  
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How do we not upset Mom’s routines if we hire an in-home helper?

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April 19, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Narrow your candidates down to two or three and then invite them into your mother’s house to observe them interacting with her. This should be very enlightening and help you trim the choices further. Look for someone who is kind and attentive. Other things can be taught, such as where things are and where they belong, how routines are run and tips on how your mother likes baths, food, dressing, etc. But if a good spirit and healthy interaction aren’t there between two people, that’s hard to overcome. It’s very hard to force after the fact. Involve your mother as much as possible in the selection process. Even if she has late-stage Alzheimer’s, she can tell you in her own way what she thinks about the candidates. It might be through a gesture such as a wrinkled up nose or a thumbs-up or -down. Or she might resist giving an opinion at all. This is not insurmountable. If she does not consciously want to help you through the selection process, observe her body language around the candidates. How does she respond to each? Once you have hired a helper, bring her or him in one day before the official start of work. Give this person plenty of time together with your mother so they can bond and get to know each other better. By all means, let your mother know what is happening, and that this person is going to be with her for long periods. Be firm but sympathetic. Tell the hired caregiver about your mother’s likes and dislikes with regard to food, activities and other situations. The better the caregiver and your mother know one another, the better the care will be. Some people like to start a new caregiver with just a few hours of work the first day. This helps let your mother know her world has not been suddenly 100% turned upside down. You should keep a good, professional relationship with the caregiver. Encourage this person to call you with information — good or bad — about your mother. Constantly check with your mother on how things are going. Let her express her feelings. If she is unable or unwilling to tell you anything, you still can learn a lot simply by observing her body language. This is vital for determining whether you should keep a current caregiver or move on to another one. 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 mom has Alzheimer’s and will soon live with me, but I need to hire a caregiver. How can I make sure I get a person with the right skills?

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April 10, 2012

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

This will depend heavily on how much care your mother requires. A private agency or home health provider can help determine what skill levels are needed and find you a suitable worker. You might need somebody just for housekeeping-type chores, such as cooking and cleaning. If your mother has not moved past the beginning stages of Alzheimer’s and remains fairly independent, you might want to hire a sitter so she isn’t left alone. If this is the case, make sure you specify you want a sitter with experience with dementia patients. If your mother requires more help with things such as bathing, toileting or dressing, you will need a certified nurse aid, or the equivalent. A nurse would become involved only when your mother would require skilled services. These become needs typically after a hospital stay. A home care agency can provide the aid and advice you require. An agency will do the background checks, actual hiring, training and payment of the worker — and dismissal if/when it’s needed. Many people think it’s worth it to pay for this bit of extra support. If you hire an assistant on your own, you can count on spending a lot more time on the particulars, though the monetary cost will likely be lower. Again, depending upon your mother’s abilities, adult daycare is another option. Your mother could attend all day and get any or all of the services mentioned above taken care of. She would receive supervision, meals, activities, socialization and assistance as needed. For you, as a family caregiver/hostess, it will give a needed break. Your mother probably also will like the change of scenery and socialization, among other things. And she should get good care. This is a scenario many people face. Remember to go with your gut feeling when you are dealing with anyone caring for a loved one. If you are not entirely — as in 100% fully — comfortable with a person charged with taking care of a loved one, you should reconsider and make changes as necessary.  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 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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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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What can I do to make my house safe for an Alzheimer’s patient?

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March 8, 2012

- Alzheimer's Care, Blog, Elder Law Articles

A person with Alzheimer’s is likely to walk, pace or wander. As a caregiver, you must allow this type of behavior. But you have to create a safe environment for it. People with Alzheimer’s have perception problems. Carpeting or other flooring with black patches can give the appearance of black holes that have to be stepped over. Shiny floors might appear to be wet, also causing altered behavior or motions. Good lighting that reduces glare will ease anxiety. Get the clutter out of the house! It is very important that things such as plants on the floor, footstools, baskets, and any papers or magazines not be left lying around. Remove these and any other things that could be construed as obstacles. There are many vendors that have products that can increase home security appropriately. In fact, there are so many products, a prudent review of their capabilities, costs and pros/cons is in order. Some have bells or alarms, while others can quietly page or notify someone off-site. There are special locks and door aides that also can help keep individuals with dementia safe. Monitoring equipment is plentiful. A common baby monitor works especially well for monitoring at night. If your loved one is prone to falling out of bed, lower the bed (even putting the mattress on the floor) and/or put an extra mattress(es) next to the bed to cushion any tumble. There are also monitors available that can tell you whenever your loved one gets out of bed, or rises from a chair. A good place to find out more about home safety devices is http://www.alzstore.com. Places that sell baby-safety equipment are also good, as are outlets such as Radio Shack. There are plenty of manufacturers and sponsors out there — be sure to compare prices and quality whenever possible. For further information, please access our FREE  “Indispensable Alzheimer’s Resource Kit” by clicking here.  
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Does pain — such as from a UTI — worsen the effects of Alzheimer’s?

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March 6, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Pain can worsen confusion, agitation and/or depression in someone with Alzheimer’s. But pain itself does not cause a decline in Alzheimer’s symptoms.  Pain can be a terrible puzzle when dealing with someone with Alzheimer’s. Because many times the person with Alzheimer’s can’t communicate adequately, he or she will resort to wandering, sleeping, grimacing or being agitated — or shutting down altogether. Take a cue and watch closely because if your loved one has a sudden change in behavior (such as confusion, for example), it’s possible he or she is experiencing pain or discomfort. This could be anything from an infection to simply having shoes that are too tight. When caregivers work with cancer patients, their goal is to keep the person as comfortable as possible by eliminating or soothing the pain. It should be the same with individuals with Alzheimer’s, no matter what the stage or age. They should be comfortable and pain-free. A urinary tract infection (UTI) definitely can cause pain. Its symptoms include burning, itching and inflammation. Treatment is neither complicated nor invasive and will increase quality of life. For other chronic pain-producing conditions, such as arthritis, a person with Alzheimer’s should continue treatment according to doctor’s orders. For things like sore throat, backache, headache and foot pain, seek a doctor’s advice as necessary — do not let the condition linger too long or get out of hand. Depression is not uncommon for individuals with pain. If a loved one who has Alzheimer’s is suddenly a lot less enthusiastic about previous interests, it could be a sign he or she is experiencing pain. Be aware, however, that people also can act this way when there is no pain present. 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?

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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?

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

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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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