Minding Our Elders®

Mom resists help handling finances

Dear Carol: My 82-year-old mother wants to go to her bank to renew a certificate of deposit. She seems competent, but my brother and I feel someone needs to go along with her. The bank has been pressuring her to buy an annuity, and we’re not sure this is wise. Since my brother’s name is on the checking account, he has offered to go along with Mom to do her banking, but she refuses. We respect her independence, but she has made several foolish financial choices in the past, and we’d like to protect her. Are our concerns normal?  - Norma

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Are you approaching caregiver burnout?

When you are taking care of a parent with Alzheimer's, you are trying to cope with your own grief over their illnesses, help them with their feelings of loss, keep them safe, make your immediate family reasonably content and work at your job. You are wearing out, but caregiver guilt won't let you say – enough!

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Nearly every caregiver will have negative thoughts at times

Elders in need of constant care feel their own pain. They generally feel a lack of control over their lives, as bit by bit their abilities slip away. This can make some of them disagreeable and bossy. Generally, the answer to this is to learn to detach with love.

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When a loved one with dementia accuses you of stealing

Have you ever looked for something you are sure you left in a particular spot and found it missing? Most of us have. Sometimes, we even wonder if someone in the family moved the object, since we are so sure we left it in that spot. Later, we find the missing object, and then remember when we moved it. If we're lucky, we didn't actually confront a family member for "messing with our stuff," and our minds are presumably normal.

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Breaking the news to a loved on about the need for hospice care

Our culture has historically been devoted to cure illness at all costs, and death is often looked at as "failure," no matter the age or condition of the person being treated. Many other cultures readily accept death as part of the life cycle. I believe we, as a culture, are making progress in this direction, but death still tends to be a word people avoid. If it's up to you to inform a loved one that he or she would be more comfortable under hospice care – or that a person they love will be on hospice care – there are steps you can take to get you through this difficult transition.

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Is shock value an appropriate approach to Alzheimer’s awareness?

A recent public service announcement broadcast in Belgium has added fuel to the controversy over how “clever” it’s appropriate to be when it comes to Alzheimer’s awareness campaigns. The Flemish League Alzheimer’s Association recently commissioned a PSA message that has brought strong responses from viewers. The PSA shows a woman with Alzheimer’s repeatedly opening her door to her grandson when he arrives only to ask for money. In real life, this obvious “fleecing” of a grandparent with dementia would infuriate nearly anyone. The controversy is over the fact that there seems to be an attempt at humor in this PSA which many viewers think is degrading to the woman with the disease. 

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Talking to kids about dementia: how to explain changes in a loved one

I'll never forget the look on my kids' faces when they first talked to their grandfather - my dad - after his brain surgery. It's unclear what went wrong for Dad, but the surgery, performed because of fluid build-up behind scar tissue from a World War II head injury, left him in a state of extreme dementia. The irony that this surgery was to prevent dementia wasn't lost on his family. The fact that this surgery is generally very safe and effective didn't help ease the pain the family felt. The kids' grandpa was no longer Grandpa as they knew him. Their expressions upon that discovery are burned into my brain.

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Daughter feels guilty for dreading time spent with her mother

Dear Carol: My 92-year-old mother is being eaten up by dementia and I am struggling with guilt because I dread visiting her. She lives in an assisted living center which she likes, but there’s no memory unit and not a lot of hands-on help. I try to give her the personal care she needs, but she hates having me assist her. She often insults me, which is unlike how she used to be. I know she acts this way because of her dementia, but I can’t help but dread my time with her. I never thought I’d feel this way about my beloved mother. At times her old self seems to shine through, though not for long. I know I should cherish this time with her, but I don’t. Then guilt eats me up. What’s wrong with me? – Renee

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Caregivers need to periodically evaluate their own lives

We keep putting one foot in front of the other, day after day. We do what is in front of us, to the best of our ability. And time goes by. Sometimes, as time slips away day by day, we live our life so close to our caregiving that we can't, as the old saying goes, see the forest for the trees. We don't notice our stress levels. We don't notice our failing energy. We don't notice our lack of enthusiasm for life.

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Making the transition from assisted living to a nursing home

Assisted living centers can often make a good transitional home for elders who no longer feel safe in their own homes, or who are so isolated at home that they are in danger of depression and other health issues. Alzheimer's organizations consider socialization one form of possible protection against the disease. Since many elders find that their neighborhoods change over time, plus many of their friends are ill or have died, a gradual isolation can overtake them without their even being aware of it. 

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Pain and dementia: observing body language important when people can’t articulate pain

A number of years back, my dad, who had developed dementia after a surgery to correct problems from a World War II brain injury, was seized by sudden, horrendous pain. While Dad had to cope with considerable pain from arthritis and some back issues, this was different. I knew his pain was acute and extreme by his body language and vocalizations, even though he couldn't articulate exactly what was wrong. Dad generally had the ability to communicate, though his dementia often skewed the information he was trying to share. However, this pain was more than he could put into words. He was writhing in utter agony, only able to moan and even holler in pain. Slowly, I realized that he thought he was being tortured.

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Guilt over placing a loved one in a nursing home

If we could control events, most of us would never want our elders to be so sick that they need the care of a nursing home, especially homes that are still operating in the dark ages, as some of them still are. Many homes have now moved forward into person-centered care, and reluctant caregivers often find their elders thrive, once they have adjusted. Still, it's hard. 

For many caregivers, placing an elder in a home spells failure on the part of the caregiver. Even when carers know they've done all they can, a subconscious nagging voice often tells them they are giving up on their parents or spouse. I'm here to tell you that you are not giving up. You are just getting help.

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Changes in nursing home environment improves Alzheimer’s care

Nursing homes of old were modeled for the efficiency of the staff, many being replicas of WWII military hospitals. Times are, thankfully, changing. Much of this change in the US has been lead by people involved in the Pioneer Network, an organization dedicated to culture change in elder care. However, world-wide, culture change in the care of the aged is happening in a big way.

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Cancer and Alzheimer’s disease: when do we treat It and when do we let go?

A friend recently came to me in tears with the news that her mother, who is in mid-stage Alzheimer's, had just been diagnosed with breast cancer. My friend was beside herself with grief, mostly because she didn't know what to do. She felt the full responsibility of making the decision to treat or not to treat her mother's cancer was on her shoulders. I had a few suggestions for her, but only she and her family can decide what the next best step is.

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Family can help loved one accept Alzheimer’s diagnosis

Dear Carol: My 87-year-old widowed mother has been diagnosed with early stage Alzheimer’s disease. She’s been quite independent, and is very upset over the diagnosis, even though her symptoms are mild. My siblings and I don’t know how to comfort her. I know she’s already thinking ahead to the worst stages of the disease.  How do we help her?  -Dennis 

Dear Dennis: Dementia is a frightening diagnosis for most people, so it’s not unusual that your mother is already projecting into what she sees as her future with the end stage of Alzheimer’s. I’d begin by making a strong statement that each case of dementia is different and that people decline in cognitive function at varying rates.

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Preserving dignity of elders should be a top priority

When speaking to groups of caregivers, I often think of the phrase "parenting our parents" as having a negative connotation. While I completely understand the analogy between caring for a child and caring for an elder in decline, I feel the phrase itself is demeaning. Yet, I've had to use references like this, myself. Sometimes, it's nearly unavoidable. But I do try. In the article "Why you can't parent your parents," I compare an elder's life to a rose - the promise of the bud, the full bloom of maturity, followed by the loss of petal after petal as the rose diminishes until all that is left is the nub of death.

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Culture creation: a concept based on person-centered care

Recently, I came across an article that made me smile - really smile. I've written copiously about "culture change" in nursing homes. Part of culture change, pushed with great skill by the Pioneer Network's great work, is that nursing homes are becoming person-centered, rather than set up for staff efficiency. The irony of all of this is that once person-centered care is in place, the residents of the nursing home are generally much easier to care for.

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Should you quit your job to care for your aging parent?

You already know what may be gained by giving up employment and becoming the sole caregiver for your parents. You are the hands-on person and know their care intimately. You know how they are doing day and night and you hope they will appreciate your help. They raised you and you want to give back.

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How helpful will new FDA approved test for Alzheimer’s be?

The contradictory nature of new studies and approaches to fight Alzheimer’s disease can be mindboggling. Just as one approach seems to show great promise, follow up information can seem to throw cold water on it. Case in point: on April 9, 2012 a Wall Street Journal online article announced that the FDA has approved a test a that detects protein levels in the brain indicating Alzheimer’s disease.

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Depression, mental illness and Alzheimer’s still carry stigma

People who have depression, dementia and other illnesses that affect the brain still suffer from social stigma. We, as a population, like to think that we are more enlightened than this, but most of us don't need to follow a study to see this stigma in action. Insurance companies still treat mental illness separately from physical illness, even though many, if not most, mental illness has a physical component. Some policies still deny coverage for mental illness or provide less coverage.

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