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Dementia and it’s troublesome sidekick Anxiety

anxietyThe speed at which my Mom could bring me into her anxiety was one of the most alarming shifts in our familiar dynamic. Growing up my Mom was the calm, low-key fixer. In the military life in which I was raised with a Dad that was often gone, Mom ran the household and raised four kids. She was as adept with a hammer and nails as she was with a spatula and pie pan. So when I started to get panicked calls from her, I usually found myself jumping in a car and driving over to visit. I figured it was now my turn to be the fixer.

There were a lot of personality changes over the years, but the anxiety was one of the issues that troubled me most. I learned when she was anxious how to not join her where she was and redirect to a calmer option. I learned to not disagree or debate what she believed, but also not join in the alarm. In the beginning, I would just excuse myself for a few minutes so I could reset my demeanor. Later, I would suggest something we could do together that would change the setting and take her focus to something else.

Puzzles were a regular feature of Mom’s room in Assisted Living. The simple act of setting it up, finding a piece or putting it away always brought calm. When it was nice, we would go for a walk in her community, and some days we just got in the car and would complete a simple errand.

The “therapeutic fibs” are often recommended for those that can’t break the cycle of anxiety they are in. I really struggled with this idea initially but found that the truth teller in me was not helpful in many situations. The most difficult were my Mom’s calls about Dad being in the hospital and needing a ride to visit him after he died. Neither of us needed to relieve his death over and over and I found the suggestion of a visit to Dad calmed her down and let her focus on what to do before I would be coming over.

As a last resort they may prescribe medicine that can help. There were several times in the early days when the doctor encouraged us to use the Ativan she prescribed. When the Life Care Community my parents lived in forced their migration from Independent Living into Assisted Living, I dissolved the pill in a glass of Coke. I started out offering the medication to her, but she was suspicious and would refuse any medication. It’s kind of humorous to me now to tell you that she was so anxious, she wouldn’t take the pill that would help her anxiety, but that was our reality.

Dementia is hard on more than just the individual diagnosed with it, and because our loved ones are usually unable to adapt to the changes happening in their brain, it’s up to us to adapt to help them. Encouraged. 

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Age-Associated Financial Vulnerability is an Emerging Public Health & Safety Issue

The Annals of Internal Medicine reported on Age-Associated Financial Vulnerability(AAFV): An Emerging Public Health Issue back in 2015. They define “AAFV as a pattern of financial behavior that places an older adult at substantial risk for a considerable loss of resources, such that dramatic changes in quality of life would result, and that is inconsistent with previous patterns of financial decision making during younger adult life.” So normal adults are at risk of becoming a victim of one of the latest frauds or scams.

This is not about older-adults with a form of dementia, but is emerging issue that is impacting the health and safety of a large segment of older adults.

As a Daily Money Manager, I am seeing this play out with adults on a pretty regular basis.  I’ve seen research on how brain changes in older adults can make us more trusting (Scientific America) and more recently have stepped in to work with highly-educated adults in good health that have been victims of a fraud or scam.

You can’t miss the stories in the news, but if you have, take a look at this recent story Age of fraud: Are seniors more vulnerable to financial scams? (Marketplace). You will get a sense of how very smart and reasonable people are getting scammed.

healthpolllonlinessNot only are these matters incredibly embarrassing, but they are finding that in many cases, they are individuals that don’t have a strong socio-emotional network around them.

I’ve walked into client engagements where there has been a recent issue, and the adults are well-educated, successful and are independent. However they usually share that they have lost a spouse, partner, and/or friends recently. It takes time to build up those social networks. Loneliness impacts a huge segment of older adults … and by “older adult” that covers individuals 50 years and older.

If you have someone in your life you can help offer to be a sounding board on big purchases or even on upcoming plans — if even just to listen. Maybe they just want a shopping partner. My hope is that we can squash these crooks by helping our loved ones have a deeper line of defense. Wished.  

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Difficult People and Dementia

see through boxersWhen I hear the statistics about older adults living with dementia, I immediately dismiss them because I believe they are just too low. I know there are many people living with dementia that were never diagnosed and so they have never been counted.

I understand why families choose not to pursue testing. However, I also know that there are so many factors that could contribute to create symptoms of dementia that some might be living with it needlessly.

There are a host of drugs that can alone or in tandem with other drugs may imitate dementia (The Washington Post).

I recently was involved with a family who were very concerned about their father. He was explained to me as a “very difficult person.” As I met with him and the woman who helps him out regularly, it was very clear to me that he had some form of cognitive issue. However, all of those around him are just chalking up his behavior as a personality quirk. The family confirms that he did not always behave in this manner, but over the years he has got more ‘difficult’.

As I was talking with him about how I could help with some of the daily money management issues it was clear he did not comprehend where some of his income was coming from — some was from military service and had been coming to him for over 60 years. There were several small things that demonstrated to me he was having trouble comprehending and processing the information. The fact that he has been unable to pay or manage his day-to-day finances is a big clue. So often I am called after there has been a financial boo-boo that was too glaring to ignore any longer. Ideally, you don’t want to strip them of their control, but just layer in some help.

My final clue was that when I met him, he was in his boxer shorts. He lives in a high-rise complex and was down in the lobby talking to a neighbor when I arrived. As we return to his apartment, I find that I can see right through his mesh boxers to skin. I mentioned this to the woman who is helping him on a regular basis and she confirms that she will ask him to put on a second pair before they leave for lunch. He is intelligent and curious, and as a man in his 90’s, I don’t think he recognized that he is walking around in public in his underwear.

I recognize all of the reasoning we used in my family. You want to respect and honor an individual, but often, it seems to reach the point of failing to possibly address the source of the behavior changes. Maybe they are caused by medication or even hearing loss (you don’t understand what your don’t hear.) For a variety of reasons, I ask that if you find yourself in this position, you advocate to get some medical attention to eliminate possible causes for the change. Suggested. 

 

According to the World Health Organization: “Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.”

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Falls are Game Changers for Older Adults

FallRiskI know you have heard or seen a lot about the risk of a fall. It seems like the smallest of worries when you are dealing with concerns over personal and financial safety.  However, it looms as one thing that changes EVERYTHING for many of the clients with which I work. It was also the pivotal event that preceded my Mom’s death.

For my Mom, ending up the Emergency Room after a fall in her Memory Care community resulted in another small stroke (or maybe two). While the doctor suggested surgery, I struggled with the idea that if she emerged from surgery, she would actually be cognitively worse and have to manage through the pain and recovery. She didn’t recognize me at the hospital and she was no longer swallowing her food. While the medical solution was surgery, I was advised to tell them she would prefer to “let nature take its course.” The initial tests confirmed that she was too frail to survive the surgery and she moved into hospice care. Unfortunately, my experience is more common than most realize.

According to The Washington Post, “researchers found that frail older women who broke hips were unlikely to fully recover their prefracture qualify of life, even after as many as 10 years.” Another study from the Journal of General Internal Medicine found that only 31 percent of the cohort they followed after breaking a hip recovered to their prefracture ability. They did find that many of the adults were already frail and had trouble walking, dressing, or bathing before the fall.

There are several things that can be done to minimize the fall risk and include:

  • Get exercise. A variety of types of exercise can help from strength training to aerobic activities. Getting someone who has never exercised to exercise can be a fools errand. My Mother never exercised but was very active and loved to walk, so we worked to get regular walks. When she needed to move into a Memory Care community, we found one that allowed her to freely (and safely) walk the grounds.
  • Take Fall Prevention Measures. Remove trip hazards like area rugs and keep the floor tidy. This is a ‘no brainer’ that can be harder to manage if your loved one is resistant to give up the rugs they have always had in the hallway, or if they don’t value a tidy room.
  • Eat Well. From addressing any vitamin deficiencies like osteoporosis or neuropathy to maintaining a healthy weight — all are contributing factors to better well-being and fitness.
  • Stop Smoking. Apparently they have found that smoking delayed the heal of a fracture!

I figured being over-prepared is the best defense. The smallest of falls can be the one event that blows up all of your well-made plans. Maybe it’s time to consider how to incorporate ways to combat fall risks into your plans. Recommended. 

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Rules of Engagement for Adult Children Caregivers

laughing-your-siblings-will-never-let-you-live-in-peace-8447044Normal families have sibling conflict … and can only expect that to escalate when it comes to caregiving. I (and my siblings) were incredibly lucky. We had our heated debates, but managed to navigate our journey and actually emerge as more connected adults. I have come to see how incredibly rare our family outcome. Maybe it was because we were losing both parents to dementia simultaneously, maybe because we actually all lived in different parts of the county … or maybe just because it was a testament to how our parents raised us.

I was the baby of the family and am not typically the one to be the primary adult caregiver. But I was the only one that was local.

When we began to have disagreements over things I thought had simple solutions, I proposed some working rules for us to work together and that we adopted. They were:

  1. Spouses are invited to participate, but only direct descendants vote.
  2. It’s okay to disagree, but not okay to be disagreeable.
  3. Majority rules on any vote unless it impacts any of us financially. If the outcome of the vote impacts us financially, the vote must be unanimous.

We also had a general agreement that we wouldn’t discuss issues outside the family meetings. It made us talk and think through all of the issues, emotions, and complications together.

At the time, we used an online site for free teleconferencing called TalkShoe. The calls helped eliminate misunderstandings and have a better understanding of how we were each approaching and dealing with the loss of our parents.

In an effort to reconnect, we recently are having sibling calls using a video conference option called Zoom.

This is no easy journey. The worse outcome is that you not only lose a parent, but you fracture other family relationships as you are all dealing with the stress, grief, and frustration of being adult family caregivers. May you find a way to make it work for your family. Shared. 

 

 

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Little Proof that Supplements Improve Brain Health

brainfitnessWhen you have two parents with dementia, you start to worry about your own cognitive outlook. I poured over the research and have been exposed to a host of “supplement plans” proposed to families throughout my work and personal life. I have yet to have anyone emerge from these plans, that typically cost over ten thousand dollars,  with a noticeable change. I’m not a doctor, and I don’t really know if there is peer-reviewed research supporting this … I know the claims are made that they are proven. I just haven’t seen them positively impact anyone yet. And I’m very well connected to hundreds of individuals with dementia … so you think a great result would be freely shared.

The Washington Post carried a snippet of the story, but you can read the full summary that Supplements for Brain Health Show No Benefit – a Neurologist Explains a New Study. Everything I have read and seen play out jives with the explanation. However, it feels better to think that a simple pill can be a cure-all.

I believe that the food we eat makes a difference and even more so, the habits we develop now can make a huge difference to how long we can manage if we start to have cognitive issues.

If you use a calendar system and a to-do list, you could find life much easier to manage should you start to have short-term memory issues. In working with a variety of clients I have found those that have a habit of using the calendar and making to-do lists have an easier time of continuing to manage and control their own affairs. They don’t make your brain lazy and are actually recommended in the classes taught by Total Brain Health.  After going through the program, I highly recommend it. If you can’t find a class, maybe consider getting Dr. Cynthia Green’s book Total Memory Workout. You will find a host of ways to rev up your recall and be more educated about what you can do to improve your own brain health. Recommended. 

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Shining through a dementia diagnosis

A recent photography contest awarded three winners for their self-portraits. All of the contestants have dementia or Alzheimer’s and was organized by the Bob and Diane Fund.

demenitaphotowinner

Elia Luciani’s self-portrait from a mirror on a dresser covered with family photographs. (Elia Luciani). Please make sure to check out the photo behind Elia in her self portrait.

As I poured over the image, I immediately broke into a laugh when I saw the portrait she has hanging on the wall behind her. Not only is family an obvious piece of the photographers sense of self, but I have to assume that is her with her hands above her head making a silly face in a similarly set-up self portrait by someone else … maybe even a husband.

I savored the moments when my gracious Mother shined through her dementia. There were days when she immediately knew me and would talk about the family, or reflect on what my Dad would have said if were still alive about something fantastic in my life that I shared with her. She wasn’t able to ever perceive her cognitive loss, but just knew that “her brain was bad.” I missed her terribly when she was alive, and that loss carries on with me now that she is gone.

I hope you will take the time to view the winners and honorable mentions. It’s inspiring to see how many are living with, adapting and shining brightly after their diagnosis of dementia or Alzheimer’s. Awed.

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