Archive for the ‘Alzheimer’s and dementia’ Category

Avoiding Depression (part 3 of 3)

Wednesday, December 22nd, 2010

PART 3 – MEDICAL TREATMENT

We’ve covered what depression is, what the symptoms are and some behavioral treatments.  I would be remiss if I didn’t mention medical treatments for dementia.  Sometimes, behavioral treatments are not enough and medication is necessary.  As the caregiver, if you see symptoms that concern you, document the type of symptoms, give a description, and note the frequency and duration over a week to a month.  Bring this to your loved one’s doctor visit.  If you don’t feel comfortable talking about it with your loved one in the room, send the physician a letter / e-mail detailing the information at least a few days BEFORE the visit, so the physician has time to review it.

Sudden changes in mood can be a result of medication changes, blood sugar issues, or other medical problems.  These possibilities need to be considered as part of the depression evaluation.

If your loved one’s doctor recommends medication, there are some things you should know:

1.  Regardless of what the pharmaceutical company advertisements may tell you, the newest medication on the market may not be the best for your loved one.  Some older tried and true medications available in generic form may actually be the best alternative for some patients.
2.  Different anti-depressant medications work in variety of ways.  Some help some symptoms more than others.  Your loved one’s doctor should consider all these things if they prescribe an anti-depressant.
3.  Anti-depressants take up to a few weeks to reach their full potency in the body.  Don’t expect immediate results.
4.  Medication works differently in different people.  Your loved one’s doctor may have to try several different medications over a period of months to find the one that works best.
5.  If your loved one is placed on a medication, keep a log (like the one recommended earlier) documenting the symptoms, frequency, duration, etc.  If you are concerned the medication isn’t working after the period of time when the doctor said it ought to have reached full effect, send the letter / e-mail to the doctor a couple of days before the visit and begin again.

Anti-depressant medications are not the silver bullet we would all like them to be, but they are one of the invaluable tools to combat depression in dementia patients.  Just like regulating anything else — blood sugar, blood pressure, etc. — it takes time to find what works for each person.  Be patient.

Avoiding Depression with Dementia (part 2)

Monday, December 20th, 2010

In the first part of this blog, I covered what depression is and the common symptoms in dementia patients.  There are two basic categories of treatment for this condition, behavioral and medical treatment.  In part 2, I’ll cover behavioral treatment  — and I’m talking about the behavior of the caregiver, not the dementia patient.

How do you interact with the patient?  Speaking from personal experience, I tried to correct everything one of my relatives with dementia would say that was incorrect, to bring him or her into reality.  This is exactly the WRONG approach.  Patients with dementia cannot be made to rejoin reality and constantly correcting them only contributes to depression.  The worst case I’ve ever heard involved a friend’s mother.  A home health nurse came to her house every day and every day, my friend’s very elderly mother would say, “I had breakfast with my mama this morning,” with a big smile on her face.  The nurse would correct her every time, saying, “Ma’am, your mother has been dead for many years.”  Predictably, tears and grief followed.  For this woman, her mother died anew every day.

This is an extreme example of what not to do.  However, when we constantly correct the dementia patient, we are reinforcing his view of his own inadequacies.  In most cases, correction isn’t necessary or kind.  The alternative is to love the patient where he is, to validate the abilities he still has, to help him find abilities he may not have had before his diagnosis.

Such was the case with my father-in-law, a very skillful man who could fix just about anything.  As dementia became more and more apparent, he realized he was losing his abilities to perform many tasks, having been so capable previously.  Enter depression.  He stopped smiling and grew frustrated and angry with his own inept attempts to accomplish tasks.  At the point at which he could no longer hammer a nail or put lights on the bushes outside, he began going to Caring Days, a local dementia daycare center.  There he learned to paint, having never painted anything more artistic than a wall or a fence before this time.  We have nearly 100 of his water color paintings and they have been exhibited all over the country, including recently in Beverly Hills at the David W. Streets Gallery just off Rodeo Drive.  After he began painting, he regained his smile and took tremendous pride in his artistic ability.

Good daycare can be invaluable in avoiding depression.  It gives the patient a purpose for getting up in the morning and mentally stimulating activity all day, in addition to giving valuable respite to the caregiver.  If you don’t have access to good dementia daycare (and I’ll cover what “good” means in another blog), try to recreate this at home as much as you can.  Help the patient find something they can do, which may or may not be something they did before their diagnosis.  Crafts, charity projects, art, music — all these are valuable tools in the fight against depression.  Especially when doing crafts or art, remember that a perfect end product isn’t the goal.  The goal is to provide cognitively stimulating activity and to make the patient feel good about themselves.  Criticism should not enter into the equation.  Also, use craft and art supplies suitable for adults, not children.

Give the patient something to do that they believe contributes to the family or the community.  For instance, one woman loved to fold and unfold clothing.  Her daughter gave her a large laundry basket of old clothes to fold.  It kept her mother busy for a long while and made her mother feel like she had contributed to the family.  Caring Days puts together care baskets for West Alabama AIDs Outreach and the patients feel like they are contributing to the community.  Everyone wants to be a contributing member of society.  Help your dementia patient be a contributor.

Keep things fun!  Humor, silliness, and fun are all valuable tools for your loved one to avoid depression (and by the way, they are valuable tools for you as the caregiver to avoid depression, too!)  Sing, dance, be silly.  Have fun!

Have you found other methods for avoiding depression in your loved one with dementia or with yourself as a caregiver?  Please share!

Avoiding Depression in Loved Ones with Dementia (Part 1)

Thursday, December 16th, 2010

Part I – What is depression?  What are the symptoms?

In the early stages of the disease process, most dementia patients know they are losing their memory or at least that something isn’t right.  This was the case with my relatives with dementia and with my father-in-law.  Depression is a nearly unavoidable side-effect.  Because depression can mimic dementia or make it worse, caregivers need to do everything they can to minimize this problem.  There are two basic approaches, behavioral treatment and medical treatment, both of which I will attempt to cover in parts  2 and 3 of this blog.  First, it’s important to understand what depression is and what the symptoms are.

What is depression?  Dictionary.com defines it as “a condition of general emotional dejection and withdrawal.” Depression is not something to be embarrassed about or ashamed of.  It’s all about the chemicals in the brain which may be produced in smaller quantities than they ought to be for depression not to be a factor.  Here are some symptoms to watch for:

1.    Anxiety (anxious expression, worrying)
2.    Sadness (sad expression, sad voice, tearfulness, crying)
3.    Lack of reaction to pleasant events (no smiling, laughing, enjoyment)
4.    Irritability (easily annoyed, short tempered)
5.    Agitation (restlessness, handwringing, hairpulling)
6.    Multiple physical complaints / Hypochondria
7.     Acute Loss of interest (disinterest in usual activities)
8.     Change in Appetite (eating more or less than usual with accompanying weight loss or gain)
9.     Lack of energy (fatigues easily, unable to sustain activities)
10.   Sleeping more or less than is normal
11.    Suicidal issues (feels life is not worth living, has suicidal wishes, or makes suicide attempt)
12.    Self-depreciation (self-blame, poor self-esteem, feelings of failure and worthlessness)
13.    Pessimism (anticipation of the worst)

According to numerous studies, depression is very common among dementia patients and very much under-diagnosed by physicians.  Be an advocate for your loved one.  If you are concerned he or she may have depression, talk seriously about it with his or her physician.

General Safety Tips

Monday, December 13th, 2010

GENERAL SAFETY TIPS:

The Alzheimer’s Foundation of America has wonderful caregiver resources, among which is this safety checklist (http://www.alzfdn.org/EducationandCare/checklist.html):

  1. Clear all passageways.
  2. Remove unnecessary furniture, knickknacks, clutter and items that may cause confusion.
  3. Fix loose or uneven steps, and loose or broken handrails.
  4. Put gates at the top of stairways.
  5. Install safety latches on cabinets that store dangerous items, such as knives, firearms, medications and cleaning products.
  6. Place guards around radiators and other heaters.
  7. Install secure locks that are higher or lower than eye level on outside doors and windows.
  8. Eliminate poisonous houseplants.
  9. Keep small objects that may be swallowed out of sight.
  10. Make sure electrical wires and phone cords are secured and cannot be tripped over, and that lamps cannot fall over.
  11. Remove or fasten down scatter rugs to prevent slipping.
  12. Put nightlights in bathrooms, hallways and bedrooms.
  13. Make sure light fixtures are easy to turn on, such as switches near doorways and glow-switches.
  14. Use maximum wattage allowed by fixtures.
  15. Reduce glare with frosted bulbs.
  16. Ensure adequate lighting by stairways and passageways.
  17. Remove stove and oven knobs when not in use.
  18. Install an automatic shut-off switch on the stove.
  19. Put away kitchen appliances such as blenders and toasters.
  20. Use non-slip decals or mats in the tub and shower.
  21. Install grab bars around the tub, shower and toilet.
  22. Try a bathtub bench or a hand-held shower.
  23. Keep the temperature gauge on the hot water heater at 120 degrees or lower to prevent scalding.
  24. Remove locks on bathroom doors.
  25. Outfit the individual with an ID bracelet or some other form of identification.
  26. Obtain a wristband transmitter or other tracking device to locate wanderers.
  27. Post emergency telephone numbers in large print near phones.
  28. Prepare and practice an emergency exit plan.

Note:
Don’t leave someone home alone—even for a few minutes—if they cannot respond to an emergency situation.
For more information, connect with the Alzheimer’s Foundation of America’s licensed social workers. Click here or call 866.AFA.8484. Real People. Real Care.

5 Holiday Coping Tips for Alzheimer’s Caregivers

Friday, December 10th, 2010

This is a great article I found on the web.  Thanks to Jennifer Scott at the Alzheimer’s Reading Room for her excellent, practical advice!

http://www.alzheimersreadingroom.com/2010/12/5-holiday-coping-tips-for-alzheimers.html.

Exterior Design

Thursday, December 9th, 2010

One of the best things you can do for your loved one’s health and safety is to give them a secure outdoor area where they can garden, exercise, and enjoy fair weather.  Just like interior spaces, though, exterior spaces need to be designed to suit the unique needs of the dementia patient.

  1. Start with a high, opaque fence.  Wide open spaces, passing traffic, and other distractions may be upsetting to dementia patients.  Make certain the gate is locked or too complicated for the dementia patient to operate.
  2. Get advice from a landscape designer or horticulturalist on the plants in your outdoor area to make certain none of them are poisonous.
  3. Designate spaces for planting annuals, especially if your loved one enjoyed gardening previously.
  4. Consider window boxes for planting annuals if getting up and down from the ground is difficult for your loved one.
  5. Add comfortable benches or gliders to sit and enjoy pleasant weather.  Rocking chairs can tip.
  6. On patios, ceiling fans can make an uncomfortably warm day comfortable.
  7. Gardening can give those suffering from dementia a sense of accomplishment and of contributing to the family.  You can encourage these positive feelings by phrasing gardening suggestions in a positive light:  “Would you please help me plant some pansies?  You are so much better at arranging them than I am,”  or “I really need your help getting this garden into shape.  The weeds have taken over!”

A word about swimming pools: Pools are a danger to dementia patients.  Those who have been swimming all their lives may get into the pool and forget how.  The perception problems of dementia make it doubly dangerous.  For a dementia patient who remembers how to swim, he may step into the pool by accident, misjudging the distance, depth, etc. Even if your loved one doesn’t venture outside, the risk of head injury and drowning is too great not to take precautions.  There are fences just for the area around the pool available through pool supply stores.

What has worked for you to help dementia patients enjoy the outdoors?  Please comment!

Visual Perception Issues in Dementia

Tuesday, December 7th, 2010

I will begin this blog with a disclaimer:  I am not an interior designer.  However, I do know some things you can do with color and design that can help your loved one maintain her independence longer and make your life as a caregiver easier.

As various forms of dementia progress, they may cause the patient to have visual perception problems.  Notice that I didn’t say “sight” problems.  Often, patients can see perfectly well, but the way their brains interpret what they see malfunctions.  There are many simple things you can do to minimize the problems this causes and to help you in caregiving.  As time goes on, most dementia patients lose their ability to perceive things of similar color tone from one another.  THE KEY is color — highlighting those things you want the patient to see with contrasting colors and “hiding” those things you do not want the patient to notice with similar tones.

  1. If the wall behind a white commode and sink is painted a light color, the commode and sink may be “invisible” to the patient.  Paint the wall behind that same sink and commode a medium tone and suddenly, the sink and commode become “visible” again, hopefully allowing the patient to retain their independence longer.
  2. If you place light colored food (mashed potatoes, corn, light colored meats, etc.) on a light colored plate, or dark colored food on a dark colored plate, the food will be invisible to the patient.  Place that same food on a contrasting colored plate and the person may be able to maintain their independence in eating longer.
  3. If you fill a clear glass with water, the patient may not be able to see it.  Use a colored cup.
  4. If you place dark pants on a dark bedspread, they may be “invisible” to your loved one.  The same holds true for light colored clothes on light colored sheets.
  5. You can also use this “invisibility” to your advantage.  If you paint doors and door knobs the same color as the wall — or even continue a wallpaper border across a door painted the same color as the wall — the patient may not perceive that the door is there at all reducing the risk of wandering.  This may not be up to code for public buildings, but you can do anything you wish in your own home.
  6. Watch you tablecloth or placemat colors.  Make certain the plate doesn’t blend in with the background.

Other Interior Design Issues:

  1. Patterns tend to confuse dementia patients.  For instance, the pattern on the carpet may look like snakes to the dementia patient.  A patterned plate may keep the patient from eating.
  2. Shiny floor finishes (think tile or highly polished wood) may look like water or ice to the patient.  Dull finishes are best.
  3. A black mat in front of a door may look like a hole to the dementia patient.  Many people have placed black mats in front of the doors leading outside and eliminate their loved one’s problems with wandering away!
  4. Place a traffic stop sign on the inside of exterior doors.  Often the color, word or shape — one of the three — will reach the patient’s mind and keep them from exiting through the door.
  5. Place reflector tape from the patient’s bed to the bathroom and use a nightlight, so the bathroom path will be visible at night.
  6. Minimize shadows.  These can be frightening to dementia patients.

Remember, just like most abilities with dementia, visual perceptions issues may come and go.  The patient is not “faking” or missing things visually to spite the caregiver.

“Together for Care” telethon

Sunday, December 5th, 2010

Dementia Dynamics’ Medical Director Dr. Daniel C. Potts was featured in the “Together for Care” telethon benefiting the Alzheimer’s Foundation of America.  The telethon aired on NBC stations across the country earlier this evening.  Also featured was Caring Days (www.caringdays.org), the dementia daycare center his father attended.

To watch the portion of the telethon with Dr. Potts and Caring Days, go to http://www.alzfdn.org/telethon/telethon_video.html?filename=AFA_Telethon_2010_Package_Caring_Days.f4v.

To watch the entire telethon, go to http://www.alzfdn.org/telethon/telethon_webcast.html.

The AFA is an excellent resource for caregivers!

Sleeplessness

Thursday, December 2nd, 2010

Most people can do anything required of them — if only they can get a decent night’s sleep.  If your loved one with dementia is up several times during the night, this can be the most difficult part of being a caregiver.  There is no magic cure for this situation, but there are several things you can try (often in conjunction with each other) that may improve your life.

  1. Make certain the dementia patient has NO CAFFEINE whatsoever after mid-afternoon.  If this doesn’t have an effect, move the “no caffeine” rule back to lunch, then to breakfast if lunch doesn’t work, or perhaps to no caffeine at all.  Remember many teas have more caffeine than coffee.  Many soft drinks also have caffeine.  If your loved one is accustomed to drinking coffee, tea or other caffeinated beverages all day, substitute the decaf version.
  2. Don’t feed the patient high sugar foods (desserts, candy, non-diet soft drinks, etc.) in the evening.  Sugar can agitate people.  Remember that bread and other carbohydrates turn into sugars in the bloodstream, so limit these, also.
  3. Try not to allow the patient to sleep during the day.  Too much sleep during the day means less sleep at night.
  4. Keep the patient physically and mentally active.  Added activity will tire the patient and prepare her for a good night’s sleep, plus it will keep her from sleeping during the day.
  5. Given before bedtime, warm milk with a little real vanilla extract added may make the patient drowsy.  There are many decaffeinated teas available that are recommended for bedtime use.
  6. When the patient is asleep, does he move frequently?  If so, he may have Restless Leg Syndrome.  If he snores, he may have sleep apnea.  Both of these can keep someone from going into a deep sleep and cause them awaken them numerous times during the night.  If this is the case with your loved one, there are lifestyle changes and treatments that may help.  Talk to you doctor about a sleep study.
  7. If these suggestions don’t work, or don’t work well enough, talk to you doctor about an over-the-counter or prescription sleep medication.

As stated in previous blogs, caregiving is a marathon, not a sprint.  You must take care of yourself (including getting enough sleep) if you want to finish the race.

Do you have things that have helped your loved one get a good night’s sleep?  Let us hear from you!

Taking Away the Car Keys

Monday, November 29th, 2010

Studies show that a frightening number of accidents in the elderly are caused by people who should not be on the road in the first place, because they have dementia.  Since this is such a touchy subject with patients and caregivers alike, those with dementia often continue to drive until they are forced by circumstances to stop.  Sometimes, those circumstances are tragic for the patient, her passengers, innocent bystanders or people in other vehicles.  If tragedies are to be prevented, the family must take responsibility for their loved one.

There are lots of excuses for not addressing the driving issue.  “She only drives in her little town,” or “I don’t really think he’s that bad, do you?” or “He doesn’t drive often and NEVER in rush hour!”  Excuses aside, the two most common actual reasons are first, the fear of the dementia patient’s reaction.  The family fears they will be blamed, and their loved one will be angry, hurt, insulted, upset, or depressed.  Secondly, the family worries about the added caregiving responsibility if the dementia patient can’t drive herself to doctor’s appointments, the grocery store, religious services, etc.  For these two reasons, dementia patients often drive LONG beyond the point when it is safe.

As the family member(s) responsible for the dementia patient, you must be proactive about driving.  A Pennsylvania woman with Alzheimer’s disease, who lived alone and still had possession of her vehicle, was reported missing by a family member and multiple law enforcement agencies were notified.  She had no GPS bracelet, which would have allowed police to find her soon after she was reported missing.  More than 24 hours later, she was found dead in her car.  Apparently, she had crossed into New Jersey, come to a near stop on the New Jersey Turnpike, was struck from behind by an SUV, and struck again by a tractor trailer truck, the force of which pushed her car into a concrete median.  This is just one of the many PREVENTABLE horrific stories that occur when families don’t take the initiative to stop a loved one with dementia from driving.

The cost in human life and well-being is certainly the primary concern, but additionally, the family could be held liable if they knew their loved one had dementia, but did not stop the person from driving.

Nothing is worth risking precious lives and your family’s financial well-being.  It isn’t pleasant to take away the keys, but here are some ways to make it easier:

  1. Take the patient for an eye examination.  Given the prevalence of cataracts, macular degeneration and other eye conditions in the elderly, your loved one may be forced to give up driving because of poor eyesight.
  2. Get your loved one a driving evaluation.  First, check your state’s requirements, as many states have begun requiring driving evaluations beyond a certain age.  If your state does not require it, ask his physician to order a driving evaluation by an occupational therapist.  This will give you objective information about whether or not is it safe for your loved one to drive.  My father-in-law had this evaluation one year and recognized 17 of 18 road signs.  One year later, he recognized 1 of 18 road signs.  We were flabbergasted.  His physician took the keys away from my father-in-law in the office when my father-in-law received the test results.  If you can find a doctor who will do this, it is an incredible blessing, as it keeps the family from being the “bad guys.”
  3. If the cost of a driving evaluation is a concern, there are other options.  If your loved one has ever gotten lost in familiar territory or has trouble performing daily living activities, she should not be driving and the physician should not have a problem taking away the keys, even without a driving evaluation.  The American Medical Association offers a kit called, “The Physician’s Guide to Assessing and Counseling Older Drivers” which gives guideline and assessment tools.  It’s available at http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/older-driver-safety/assessing-counseling-older-drivers.shtml.  You can print this and take it to your loved one’s physician.
  4. If your loved one has a fixation on a certain car, detach the battery.
  5. Sell the patient’s car.
  6. Give the car to a younger member of the family and appeal to the dementia patient’s sense of “helping the younger generation.”
  7. If all else fails, see if you can get the driver’s license bureau employees involved in keeping your loved one off the roads.
  8. Once you have taken the keys away, hide them.  I have known men especially who have taken the keys back.

Usually (not always), the patient will grow accustomed to the idea within a reasonable amount of time and cease to ask about driving.  My father-in-law was adamant about being able to drive, but within a couple of weeks, he didn’t ask about it anymore.  My grandmother gave her car to me, as I had just turned 16, when she got to the point she should not drive.

Physician involvement is key if you believe the patient will have serious problems giving up driving.  It makes it so much easier for the family to be able to say, “Remember?  Here is the paper from Dr. Jones saying that you shouldn’t drive anymore.”  Statements by the caregiver like, “I’ll drive today.  I need the practice!” are good to keep patients from arguing with you.  Eventually, the person usually stops talking about it.

We welcome the benefit of YOUR experience as a caregiver!  Please comment on our blogs!