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December 2012

An Elder’s Fall Can Cause Lasting Trauma

Dear Carol: Reading your column has helped me care for my 83-year-old mom who has Alzheimer’s disease. Now, I’m writing with my own question. Mom fell while in the memory unit of a very good assisted living center. She had a urinary tract infection and the doctor thinks that’s what caused her fall. The UTI is now cleared up. When she fell, she cut her head badly, needing several staples to close the wound. She also suffered a back injury though no broken bones. The facility couldn’t care for her after she was released from the hospital, so she’s in a skilled nursing home. It’s been three weeks, yet she’s still confused and agitated, far worse than before the fall. Mostly she just sleeps, or sits and stares at nothing. Her physical injuries are healing but she seems to be getting worse overall. What is going on? – Mary Ann

Dear Mary Ann: Your mom’s been through significant physical, mental and emotional trauma that would be tough on someone much younger and not fighting dementia. I think you need to expect that her current condition is natural considering her age, her dementia diagnosis and all that she’s been through.

Read more about accepting Mom's new health status:

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Chronic inflammation shows strong link to Alzheimer’s according to study

Acute inflammation is the body's natural response to tissue damage. Its purpose is to defend the body against harmful substances, dispose of dead or dying tissue and to promote the renewal of normal tissue. Therefore, inflammation is normal if we are ill from a virus or bacterial infection or we injure ourselves.  However, chronic inflammation is different. Chronic inflammation is involved in many autoimmune diseases including rheumatoid arthritis, allergies and even some cancers. Mounting evidence is now showing that chronic inflammation is also likely part of the Alzheimer’s puzzle.

Read more about chronic inflammation and Alzheimer's:

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Emotionally Descriptive Words Lose Meaning with Semantic Dementia

Personality change is the hallmark of frontotemporal dementia (FTD), but a small percentage of people with FTD experience an additional problem. They lose the ability to understand the meaning conveyed by words that describe emotion. People who love someone with this variant of FTD, which is called semantic dementia have to live with increased heartache knowing that their loved one is now unable to understand emotionally expressive phrases such as "I'm sad" or "I love you."

Read more about how emotional words can lose meaning with dementia:

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Memantine May Help Prevent Damage from Mini-Strokes

Unlike Alzheimer’s disease which is still poorly understood, it’s well accepted that vascular dementia is caused by strokes, often a series of small, “silent” strokes. While early stage Alzheimer’s is characterized mostly by memory loss, vascular dementia more generally affects executive function, multi-tasking, problem-solving and reasoning. It’s important to understand that more than one type of dementia can be present, which can further complicate a diagnosis.

When people are having a major stroke, they are likely to be aware that something is happening that could cause significant damage unless immediate medical intervention is sought. However, the undiagnosed mini-strokes that can result in mild cognitive impairment leading to vascular dementia often occur without any immediate evidence that something is wrong.

Read more about Memantine and vascular dementia:

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Chronic Pain Management in People With Dementia Complicated

The combination of chronic pain and dementia is difficult to manage. While advancing dementia can render an elder heartbreakingly vulnerable, chronic pain that can’t be expressed in words by the person with dementia multiplies the difficulty of compassionate care.

Since dementia can leave people unable to verbally express the fact that they are in pain, they may scream, kick or hit. They may act out aggressively because they don’t understand why they are in pain. They just want it gone. If caregivers misinterpret the reason for this “acting out,” there is a chance that the elder will not receive proper pain management for his or her chronic or acute pain.

Read more about managing chronic pain with dementia:

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Tips for New Caregivers

For me, caregiving began with an elderly neighbor who needed some assistance. This "assistance" turned into a five-year stint of elder care, closely followed by the ever increasing needs of six of my own family members. For all but one of my elders – my dad whose failed brain surgery sent him into severe dementia – care needs gradually increased.

I can clearly remember the day when I finally woke up to the fact that I had a full-time job as a caregiver, even though, technically, I wasn't "working" at the time. Had I had more family caregivers to communicate with, I may have realized earlier how much mycaregiving role had slowly overtaken my life.

Read more about questions potential caregivers should ask themselves:

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Dementia and the Holidays: Still Liking Our Loved Ones When It's Over

It’s not news that most of us are busy, even stressed, during the holiday season. However, when we are caregivers our stress level can soar. Being flexible and forgiving may be the key to getting through the season with some sanity intact. Flexibility is important because our loved one, especially if he or she has dementia, will likely be unpredictable. What we planned with great care could suddenly be the wrong approach when the special day arrives and we’ll need to adjust to reality.

The ability to forgive is important because we may find ourselves the brunt of criticism from well meaning people, related or not, who don’t agree with how much or how little we include the person with dementia. It’s also important to forgive ourselves if we make a decision that backfires. We are human.

Read more about getting through the holidays still liking our loved ones:

Ask Staff for Advice When Visiting Elders in Nursing Homes

Dear Carol: My husband and I are traveling this Christmas and want to take a side trip to visit my aging aunt who is in a nursing home. My aunt has Alzheimer’s disease, which we don’t have experience with. Besides that, we are both uncomfortable in a hospital setting and haven’t had experience with nursing homes. What should we consider? – Jen

Dear Jen: It’s wonderful that you plan to visit your aunt, and you’re on top of the game just by recognizing that there may be a protocol to consider when visiting a nursing home. Remember that people in nursing homes are not hospital patients. The nursing home is their real home. Just like the rest of us, they likely feel most comfortable staying with their daily routine. I’d call the nursing home ahead of time and identify yourself as your aunt’s niece, then ask to speak with a nurse or social worker about the best time to visit. You may also ask if there’s something appropriate you could bring.

Read more about visiting elders in nursing homes during the holidays or at other times:

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Don’t Sweat the Small Stuff: Bloopers Can Add to Family Christmas Stories

No matter how well we plan, most of us have some loose ends to tie up Christmas Eve day, just before going to church or having the family gather at our home. The present that was ordered early and then delayed remains in question. Will it arrive in time? The fruit tray reserved at the grocery store. Will it be there when we arrive to pick it up?

Probably more worrisome for caregivers is how their aging loved ones will make it through the family events. Will Dad be sleepy from his medications or agitated from all from all of the excitement? Will Mom’s touchy stomach allow her to eat her favorite foods or will you spend the evening wondering if you need to make her a nutritional shake to drink while everyone else eats?  Will Aunty throw a tantrum over the fact that no one made white chocolate fudge this year and, well, Christmas isn’t Christmas without white chocolate fudge?

Read more about how "bloopers" can actually make Christmas more fun:

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Photo Albums and Memory Books Helpful When Visiting Elders

Many people are reluctant to visit elders, whether they are in their homes or a facility, mainly because they wonder what they’ll talk about. While this reluctance is more of a worry if the elder has memory problems from dementia, it’s often a problem even when memory isn’t an issue.

Since elders by definition have many decades of life to their credit, they will likely enjoy looking back on the past. This is especially important when people have Alzheimer’s disease, because their disease prevents them from forming new memories. Nearly everyone enjoys reminiscing to some degree. To help you kick off a nice visit with the elder you intend to spend time with try bringing some props. Physical reminders should help your visit go more smoothly.

Read about ideas for spurring memories:

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