Minding Our Elders®

Mom with Alzheimer's wants to see her young sons

Dear Carol: Mom is 93 with mid-level dementia. She is constantly asking for her sons, but when she sees them, she says they are not her sons and she gets upset. She thinks something has happened to her children. Needless to say, this frustrates us all, mostly because we hate to see her so confused and in emotional pain. How on earth do people handle this? - Angel

Dear Angel: As hard as your mother’s confusion and anger are to accept, her behavior is very normal for people in certain stages of Alzheimer’s.

As you’ve seen, explaining repeatedly that these grown men are her sons doesn’t help. Arguing just upsets people with AD because in their mind they are right. And they are – they are just mentally in the wrong moment of their history. Being told they are wrong only makes them more confused and anxious. Therefore, it’s likely time for some “therapeutic fibbing.” Don’t think of it as lying. You are telling her “fibs” out of compassion, not out of malice. You are being kind by not insisting she join you in your reality when she is unable to do so.

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What to do if you aren't happy with nursing home care

Family members have ways to address caregiving issues with nursing homes. Attitude and the chain of command are both important, but every caregiver has someone on their side if they need more assistance. That person is your ombudsman.

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Assisted living combines help and social life

Assisted living centers are attractive to many people who are isolated in older homes, with neighbors they no longer know and yards that are too much work. Not everyone wants to make this move, but many do it anyway, if only because they must have help at hand for emergencies. Often, once a period of adjustment has been endured, elders thrive in these communities.

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Depression among caregivers high: get help

Numerous studies have shown that depression is a huge risk for many caregivers. People generally go into caregiving out of love, giving no thought to the fact that caregiving for an elder could go on for years. Quality of life for both caregiver and care receiver can erode as the elders' mental and physical health deteriorate and the caregiver isolates. That's when depression can set in. The remedy for this depression generally rests on some sort of regular break for the caregiver. Often, the care receiver enjoys a change of pace as well.

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Coping with outsiders who criticize your caregiving choices

One of the saddest letters I've gotten from readers was from a woman who had cared for her Parkinson's stricken husband for over a decade. Her whole life revolved around his needs. Eventually, it became too much for her. He froze up when she tried to physically move him. His memory was affected. His sheer size became too much for her. She couldn't handle it, and his needs became too complicated even for in-home help. She had to resign herself to putting him in a nursing home.

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Loneliness can cause some elders to turn to alcohol

Many an elder who only drank socially, or with a spouse, finds that a nice glass of wine at the end of the day helps ease loneliness. The once concrete rule that only alcoholics drink alone is rationalized away. When aren't they alone? The death of a long-time spouse leaves a huge hole in an elder's life. Could your elder be filling that hole with alcohol? If so, how much? What can you do to help?

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When insurance stops physical therapy what are the options?

Supporting information:

"Problems with medical billing and insurance can present huge difficulties for elderly patients and their families. It may seem like a major obstacle but there is help out there."

 

Dear Carol: What can you do when insurance discontinues physical therapy because a patient is not making enough progress? My 66-year-old sister suffered a massive stroke and was in physical therapy for several weeks. Because she was not making enough progress in her physical therapy, they discontinued her sessions. The insurance company states that there is no point in continuing the discomfort, effort, and expense of physical therapy if it is not helping, but her husband thinks she could benefit from more. Amelia

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Being a caregiver when you have breast cancer

A mentally and physically sharp woman in her early 70s, was caring for her husband of many decades who was suffering from Alzheimer's disease. The wife was coping as well as could be expected. She also was doing what many caregivers do. She was ignoring her own health needs.

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On Oct. 25, PBS will air Bill Moyers’ exploration of end-of –life issues “On Our Own Terms”

Emmy and Peabody Award-winning journalist Bill Moyers interviewed dozens of terminally ill patients to create a four-part exploration of end-of-life issues that span thoughts about everything from health care to cultural attitudes.

A press release that I received from PBS notes quotes of high praise:

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Dementia caregiver's "survival guide" useful companion

A new book titled “Alzheimer’s Disease and Other Dementias: The Caregiver’s Complete Survival Guide,” by  Nataly Rubinstein, social worker who has also has been a long-term caregiver for a family member who suffered from Alzheimer’s disease, is a winner. Her book speaks with the authority of a trained professional as well as the heart of a caregiver.

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Nursing home fear fed by headlines

There are some poor to terrible nursing homes in our country. Even one is one too many. However, these bad homes tend to grab headlines, making seniors and their families lump facilities into one category - bad. This mindset can hurt elders and their family caregivers. The need to get out and explore homes is great. The need to fight for change, if the nursing homes in your area are bad, is also great. Since many elders become so incapacitated that they need 24-hour nursing care, it behooves all of us to work toward nursing home improvement. Take the time to visit facilities in your area, and around the country, if you travel. You'll see there is a great variation in quality. Don't paint them all black with one swipe of the brush. Some are places where elders bloom.

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A Nursing Home May Be Necessary Even if You Need to Break a Promise

Nursing homes are often a necessary step in caring for our elders. For safety and health management, people who live to be very among the very old and frail frequently live in a state that needs professional nursing care. The guilt many adult children feel over placing a parent in a nursing home often reaches back to old promises and old ideas. Yet, sometimes there is no choice. Letting go of guilt is hard, but caregivers need to remember that they will still be part of the care team.

"Promise me you won't ever put me in a nursing home!" Many of us grew up hearing that plea from our grandparents or parents. The instinctive answer, of course, is, "I'd never dream of it. I'll always take care of you."

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What Do We Do When Our Elder's Behavior Is Beyond Our Ability To Cope?

Caregivers are only human. We generally get into caregiving for our elders because of our love for them. However, diseases such as dementia, Parkinson's disease and strokes, can take such a huge toll on the elder that we barely recognize the personality of the person we are caring for. They can become so difficult to manage, care can be so exhausting, guilt over not being able to make things better for them can be so overwhelming, that we don't know where to turn. How do we cope when we can no longer cope?

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Why I chose nursing home care for my loved ones

During my most active caregiving years, I had a total of five loved ones in a local nursing home. The home was just two blocks from my own house and very close to where all of my elders had lived, so the neighborhood and the building were familiar to them. How much that mattered to my elders I'm not sure, as driving by a nursing home or even visiting someone there is much different than living in one. However, the convenient location certainly helped me.

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Families need to communicate to plan for aging loved one's eventual care

For me, caregiving was never a conscious decision. I grew up with regular family visits to my grandparents. Eventually, my paternal grandmother, who was severely crippled by rheumatoid arthritis, came to live with us in our home. My parents built a house specifically to accommodate her needs. My maternal grandparents were in good health until their mid-eighties. At that time, my mother, the geographically closest of the adult children, assumed the caregiving role for her parents, as well. As I've said, I never gave elder care a second thought. That was what people did.

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Stephen Ministers can help with grief support

Dear Carol: My mom has multiple sclerosis and Dad took care of her for years. Eventually, she had to go into a nursing home, but it was near their apartment and Dad remained a dedicated caregiver. Things went well until Dad died of a sudden heart attack. Since there was no one left for mom, and the three of us kids live in different towns, we decided to move mom to a very nice nursing home near me, the oldest daughter. Mom is so devastated by Dad’s death that she doesn’t care about anything, including the move. Her doctor here has her on an antidepressant which doesn’t seem to do much. She’s a very devoted Christian and just wants to “join” Dad. How can I help her live a better quality of life? - Freddie

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Nursing homes: consistent assignment of caregivers important

Think of it this way. A person comes to your door or into your room if you are living in a care facility. You've never met this person, but he or she announces that it's time for a bath. The person proceeds to help you get ready for your bath, while you remain confused and frightened. Who is this person? Why do they want to give you a bath? What would you do? Likely have the "fight or flight" response which is wired into human brains, right? The modern approach of consistent assignment, which means that the person needing care is assigned a specific caregiver, is a big step forward in this regard. A care receiver is much more likely to respond well to a person they know and like.

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Caregivers can be subject to abuse by their care receivers

When we think of domestic abuse in a family where elders are cared for, we generally think that the elder is the most vulnerable person to suffer abuse. Likely, statistics would prove this to be a fact. However, there are many caregivers who can truthfully say that they are emotionally, verbally and even occasionally physically abused by their care receiver.

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Would you want to know if your children or grandchildren carry the AD gene?

There are many diseases where early knowledge can be a life saver, cancer being one that comes to mind. Other disease - those which have no potential cure - can leave us with a murkier understanding of the value of early diagnosis.

Alzheimer's is one such disease. Recently, CBS News ran a segment about the DIAN study (Dominantly Inherited Alzheimer Network). DIAN is an international research partnership of scientists devoted to understanding a rare form of Alzheimer's disease that is caused by a gene mutation. It generally strikes people at a relatively young age. Called early on-set Alzheimer's disease, this form strikes before the age of 65, but has been known to show symptoms in people as young as their mid-30s.

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Should your parents to move closer to family?

I live on the Northern Plains, where winters are about as harsh as they get without going to Alaska. We are known to offer a good quality of life for families, with low crime, good schools, choices in higher education and neighborly people. We are also known to have deep snow, icy streets and howling winds a good portion of the time between Halloween and Easter. Not a pretty picture for a new retiree with aching joints and a hankering for warmth and sun.

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