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Role Reversal: Parenting Your Parents

With people living longer, there are more adult children providing care to an aging parent. A study conducted by The National Alliance for Caregiving and the AARP Public Policy Institute concluded an estimated 34.2 million American adults (14.3% of all U.S. adults) have served as an unpaid caregiver to an older adult within the prior 12 months (2015). The study later determined on average, caregivers of an older adult spend 24.1 hours per week providing care.

As a Geriatric Care Manager/Aging Life Care Expert™, I am often consulted by adult children who are increasingly concerned about their parents. Generally, the adult children live out of state and/or have busy lives (work and raising a family = sandwich generation) and feel completely helpless managing the increasing needs of their parents. While some children are firm with their parents and initiate services that they deem necessary, most children are affected by the parent/child relationship while battling their awareness that they must step in to keep their parents safe. I have heard clients say, “Mom will not listen to me” or “I can’t tell Dad to do that”. If you are in this situation, you are not alone.

The term “Parenting your Parents” is not intended to construct the idea that your parents are children or that you are their dictator, but rather to depict the emotional struggle that many adult children experience when they begin to provide more care for their aging parents. Your parents have a personal legacy that must be respected. We cannot; however, neglect the emotional toll that occurs when an aging parent begins to change and are at risk of hurting themselves or be taken advantage of. There are several factors to consider when caring for aging parents.

Be Proactive:

  • If you know your parent will need more help in the future, do not wait for a crisis.

  • When you’re in a crisis situation, you tend to make quick decisions based on need, which may be different than the decisions you would make if you had more time to research.

  • Start discussions with your parents. It is important to involve your parents in the planning of their future as much as possible. Knowing their desires while they are able to express them allows you a better opportunity to align your decisions with their wants and needs.

  • Do NOT promise a parent that they will stay home forever. It may not be a feasible option. Check into available elder placement options in your area. If your parents are up to it, schedule a tour. Most facilities will also provide lunch in addition to the tour.

Get Assistance:

  • Engage a Geriatric Care Manager/ Aging Life Care Expert™ early on:

    • By bringing a professional in early, your parents can build a rapport and the care manager can understand your parents true baseline.

    • Care managers are experts at avoiding crisis situations if possible, but if a crisis does occur, they can assist with any arrangements needed and provide guidance and support.

    • Often times your parents are more receptive to the suggestions from an “outsider”.

  • Prepare legal documents such as power of attorney and advanced directives. There may also be government programs your parents are eligible for. An Elder Law Attorney with or without a Geriatric Care Manager can assist getting through these processes.

  • Ensure finances are adequately protected. A financial advisor and/or an Elder Law Attorney can assist in preserving and protecting assets.

Understand Your Role:

  • It is exceptionally difficult when roles are reversed and you may be afraid to make certain decisions, as to avoid upsetting your parents. It is important to remember that when they lack the ability to advocate for themselves, they need you to advocate for them.

  • Your parents may (and probably will) push back. If a parent is making bad decisions that could lead to serious consequences, you have to look past their anger and know that you are acting in their best interests.

  • If your parents can make some good decisions, allow those decisions. You also want them to feel like they are a part of the process. Try suggesting things in a way that allows them to think it is their idea. Be creative.

Seek Support:

  • Caring for your parents is a difficult task and cannot be done alone. Seek support from family members and friends. Set up a calendar and allow others to plug themselves in to help. There are several websites that help with organization such as Lotsa Helping Hands www.lotsahelpinghands.com and Alzheimer’s Association www.alz.org/care/alzheimers-dementia-care-calendar.asp

  • Do something for yourself and take care of your health. Go to your doctor’s appointments, get exercise or get a massage. You cannot take care of your parents if you don’t take care of yourself.

  • Go to a support group with other adult children that are facing the same struggles. They often have advice or resources that would be useful to you.

Keep in mind, your parent is losing a part of their independence, which is difficult for anyone, at any age. To find an Aging Life Care Expert in your area, go to www.aginglifecare.org

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Obtaining the Correct Dementia Diagnosis

Obtaining the correct dementia diagnosis is imperative in management of symptoms and improving quality of life. While Alzheimer’s disease is the most common form of dementia, there are many other dementias with different characteristics. Some dementias may even emulate Alzheimer’s disease initially, but later characteristics that are not common in Alzheimer’s disease begin to develop. In my practice, I have seen an increased incidence of misdiagnosis of dementia and have seen the effects of mismanagement due to an incorrect diagnosis.

Lewy body dementia (LBD) is a type of dementia that is commonly misdiagnosed. LBD is not a rare disease; according to the Lewy Body Dementia Association, the disease affects 1.4 million individuals and families in the United States alone (2015). Initially, LBD can resemble Alzheimer’s disease with symptoms of forgetfulness, confusion and difficulty with executive function. As the disease progresses, symptoms related to sleep, behaviors and motor disturbances are realized.

Lewy bodies are abnormal proteins that affect chemicals and neurotransmitters throughout the brain. The presence of Lewy bodies led to many symptoms, some of which that are associated with Parkinson’s disease. This is no coincidence. In Parkinson’s disease, Lewy bodies are also the culprit to symptoms associated with the disease process.

So how does one know the difference between Parkinson’s disease and Lewy body dementia? It depends on what came first. If a movement disorder presents first and are present for a year before symptoms of dementia then Parkinson’s disease is the diagnosis. If symptoms of dementia are present first and present for one year prior to a movement disorder then Lewy body dementia is the diagnosis.

Movement disorder + 1 year or more + dementia symptoms = Parkinson’s disease

Dementia symptoms + 1 year or more + movement disorder = Lewy body dementia

Symptoms associated with Lewy body dementia include:

  • Movement disorder - Parkinson symptoms including shuffled gait (walking), lip smacking, tremors, rigidity (stiffness), blank stare and drooling

  • Sleep disturbance - REM sleep disorder, may act out dreams, screaming and thrashing in bed is common

  • Cognition - Varies, individual may be alert and oriented and other times have anywhere from mild-severe dementia symptoms and/or abrupt confusion

  • Autonomic dysfunction - Due to the way the brain is affected, individuals may have fluctuating blood pressure (especially when sitting or standing up), which can led to fainting; other symptoms may include constipation, urinary issues, sweating, intolerance to heat and difficulty swallowing

  • Behaviors - Individuals with LBD are more likely to have psychiatric disturbances such as delusions and aggression. This can be associated with hallucinations, which are quite common with LBD

As indicated earlier, a proper diagnosis is crucial. LBD tends to react poorly to typical treatment for Alzheimer’s disease and other dementias. In fact, an individual with LBD may have a paradoxical reaction to medications, in that, behaviors, hallucinations and even movement disorders may become worse. I have seen people try many different medications, to include antipsychotics, with no success. This is because they are trying to treat Alzheimer’s disease or another dementia. There are medications that can help, but the right diagnosis is needed first. If you suspect your loved one has LBD, talk to their physician. It is also helpful if you keep a log of signs and symptoms that you observe and bring the log for the physician to view. You may need to consult with a neurologist or psychiatrist to get an accurate diagnosis.

Free form to track signs and symptoms: Dementia Signs and Symptoms Log Form

Going through the process of obtaining a correct diagnosis for your loved one can be difficult and time consuming, especially if your loved one lives in a different state. An Aging Life Care Expert who is well versed in dementia can assist you to get the answers and treatment options that are needed, communicate with physicians and make sure you are kept well informed. You can find an Aging Life Care Expert in your area by going to www.aginglifecare.org

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How Does Someone Die From Alzheimer’s?

Progressive destruction of the brain due to plaques and tangles causes the brain to atrophy, or shrink significantly. Normal functions of the brain are greatly affected and end stage Alzheimer’s is marked by a complete dependence with Activities of Daily Living, minimal to no communicative abilities, inability to sit up in a chair without leaning over, inability to hold head up and inability to smile. Typically a weight loss of 10% or more of total body weight is also seen.

While Alzheimer’s is a progressive, irreversible brain disease, a person does not die from the disease itself. Disease progression and death is the result of the complications of Alzheimer’s. Some loved ones may choose aggressive treatments to prolong life, while others may choose to allow the disease to take its natural course. There are many difficult decisions that are made at this time, which is why advanced directives should be completed early in the disease process.

The main causes of death related to Alzheimer’s disease include:

  • Infection - Infection is the leading cause of death with Alzheimer’s for a variety of factors. Due to the disease’s debilitating effects, a person with Alzheimer’s has a weakened immune system and are more susceptible to infections.
    • Urinary Tract Infection (UTI) - These infections are common with Alzheimer’s due to incontinence, poor hygiene, and decreased fluid intake. UTIs are often treated multiple times and eventually antibiotics are unable to treat the infection. Even with the best care, UTIs are common and can lead to death.
    • Pneumonia - Most specifically, aspiration pneumonia is common with Alzheimer’s. With advancing Alzheimer’s the ability to swallow is impaired which can lead to food or fluids entering the lungs. Aspiration does not always cause pneumonia, but the risk is high. If a person with Alzheimer’s is coughing when eating or drinking, dietary changes may need to be made. A person with Alzheimer’s should never be forced to eat. Some loved ones may choose to have a feeding tube placed for artificial nutrition due to weight loss, however there is still a risk of aspiration and pneumonia.

  • Wounds - Due to immobility, it is common for a person with Alzheimer’s to have skin breakdown. Skin breakdown can progress rapidly which may require skilled intervention. Wounds may become infected and once advanced, generally do not heal due to impaired nutrition. A bedbound person with Alzheimer’s should be turned every two hours to prevent the development of “bed sores”. Even with great care, wounds can develop.

  • Falls - Falls with subsequent injury (such as a broken bone) can increase the level of immobility and accelerate the disease process. You have probably known of or heard of an elderly person who fell and broke a bone (such as a hip) and never recovered. Additionally, if a person with Alzheimer’s is on a blood thinner for another condition, they are at a high risk of bleeding/internal hemorrhage which can be a medical emergency. If your loved one with Alzheimer’s has frequent falls and is on a blood thinner, you should consult with the physician to discuss benefits versus consequences of treatment.

  • Blood clots - Blood clots are a complication of being immobile. Blood clots can travel to various areas of the body, leading to complications such as heart attack and stroke.

  • Other medical conditions - A person with Alzheimer’s may have other illnesses that ultimately are the cause of death. For example, we currently caring for a woman who has lung cancer and Alzheimer’s. The lung cancer is affected by Alzheimer’s and Alzheimer’s is affected by cancer. She will ultimately die from lung cancer.

  • General decline - As any person gets older, is immobile, losing weight and debilitated, the body’s organs begin to fail.

It is important to keep in mind that a person dies WITH Alzheimer’s not FROM Alzheimer’s. There are many complications that occur during the disease process. Eliciting help from hospice or palliative care may be beneficial to provide assessment, monitoring, intervention, education and support (medical, spiritual, emotional and psychosocial). This is a difficult disease for anyone to manage, but there are many healthcare professionals that can be a part of your journey. Take care of yourself!

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How do I know if my loved one has advanced Alzheimer’s disease?

Alzheimer’s is a progressive brain disease; eventually your loved one will enter the advanced stage. As the disease continues to destroy neurons, areas of the brain that control everyday functions such as personal care, ambulation, and continence become compromised. While everyone’s disease process is different, there are some common characteristics of advanced Alzheimer’s disease.

Memory is the first aspect of Alzheimer’s disease that is affected; however early on, long term memories remain intact. As the disease progresses, long term memories fade away. Your loved one may not remember who you are and eventually are unaware of their surroundings. It can be heartbreaking for your loved one to “forget” who you are and you may experience anticipatory grief, which is grief that occurs prior to death. As you lose parts of your loved one, you may experience grief over what is lost. Anticipatory grief is a normal emotional response.

Deterioration of language capabilities progresses as the disease progresses. Your loved one may mumble words, have difficulty finding words, have difficulty processing what is being said, eventually becoming minimally verbal. End stage dementia is characterized by speech of six words or less. For this reason, non-verbal communication becomes important to understand. It is also important to keep in mind that someone with Alzheimer’s may need more time to respond. Allow ample time for your loved one to respond to questions as he/she searches for what limited vocabulary exists.

Mobility is affected later in the disease process. You may notice your loved one with multiple bruises and scratches. This may be an indication he/she is falling. Eventually your loved one will benefit from medical equipment, such as a walker; however most people with Alzheimer’s will not remember to use a walker. The problem with introducing a walker to someone with advancing Alzheimer’s is the person is unable to learn new information. A walker can become a fall hazard if adequate supervision is not provided. Your loved one will become less mobile as time goes on and eventually need assistance with transferring. In end stage Alzheimer’s your loved one will be bed bound and require complete assistance. The lack of mobility leads to other issues that are generally the cause of death with Alzheimer’s disease.

The ability to provide self-care diminishes throughout the disease process. You may notice your loved one has little to no interest in bathing, changing clothing or keeping up appearance. Previous blogs address the causes of this behavior and provide tips. As the disease progresses, your loved one forgets how to use common items such as a toothbrush. As your loved one forgets how to perform common tasks, you will be taking over those responsibilities. Late in the disease process, your loved one will need assistance with all activities of daily living such as bathing, dressing, and eating.

Sleep patterns change in numerous ways throughout the disease process. Sundowning may occur, which can lead to increased agitation and difficulty sleeping at night. As mobility and ability to provide self-care changes, your loved one will sleep more. Generally your loved one will sleep as long as there is no arousal.

Weight loss is common in advanced Alzheimer’s. Initially, many people with Alzheimer’s gain weight due to forgetting they already ate. They also tend to eat nutrient-lacking foods, such as cake and ice cream. As the disease progresses, the part of the brain that controls appetite is affected and your loved one will have a poor appetite. It may also be difficult to get your loved one to drink fluids. Keep in mind that it is normal for appetite to decrease. Try providing multiple small meals and sips of water throughout the day, provide foods that are soft and easy to eat, provide finger foods, and provide nutritional supplements such as Ensure.

Developed by Dr. Barry Reisberg in 1984, the Functional Assessment Staging of Alzheimer’s Disease (FAST) demonstrates the progression of Alzheimer’s disease in a simplistic fashion. The following website explains the FAST scale in detail: www.geriatrics.uthscsa.edu/tools/FAST.pdf Hospice criteria for Alzheimer’s disease is a FAST score of 7a or greater.

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Agitation in Alzheimer’s Disease

Agitation is a common occurrence with Alzheimer’s disease. This can be particularly frightening, especially when behaviors turn aggressive. As a nurse, I have cared for many agitated Alzheimer’s patients and have memories of being hit, yelled at and even had food thrown at me (chocolate pudding all over my scrubs!). If you’re reading this, you probably had similar experiences. While these are obvious symptoms of agitation, there are other symptoms to be aware of.

Symptoms of agitation that can escalate include emotional outbursts, delusions, hallucinations, pacing/wandering, frequent movement, use of threatening language and pulling at clothing or other items.

Agitation can be the result of many causes:

  • Medical conditions and medication side effects - should be examined first. A major cause is infections, especially urinary tract infections (UTI). When you experience agitation due to a UTI for the first time, you tend to be on alert for signs and symptoms. My first experience with a UTI in an elderly person was as a new grad nurse. I worked on an Intensive Care Unit (ICU). Most of the time my patients were on a ventilator with multiple tubes and IVs. At the beginning of my shift, the nurses were discussing which patients they would take and I couldn’t understand why none of them wanted this lady in her late 80s who did not have the usual ICU equipment. I thought, are they crazy? Come to find out, I was crazy. I took that patient, who had Alzheimer’s and a UTI. Let’s just say it was a long night.

  • Changes in environment - moving to a new location, changing out furniture and changes of those involved in care can cause confusion and lead to agitation.

  • Fear - real or imagined, can be caused by poor sight or poor lighting in a room; delusions and hallucinations can be fearful as well.

  • Fatigue - I for one get agitated when I am tired, so imagine a person whose entire world is confusing.

If possible, we want to prevent agitation from occurring in the first place. This can be done by ensuring a calm environment, using soothing rituals, removing triggers, use adequate lighting, have vision checked, promote daytime activities, allow for periods of rest, provide routine, and assess for causes of agitation such as pain and constipation.

When dealing with a person who is agitated it is important to remember that the person is living in a world that no longer makes sense. As the caregiver/loved one, we must step into their world. We must also put on a detective hat and try to figure out why agitation is occurring. As mentioned before, agitation can be caused by pain, constipation, full bladder, hunger and many other physical occurrences. Address physical issues and treat discomfort first. Additionally:

  • Provide redirection - go for a walk, try a different activity, look at pictures, provide a snack (sweets prove to be helpful).

  • Reassure - make sure the person knows they are safe and that you will stay with them. Use terms like: May I help you? I apologize. I am sorry you are feeling this way.

  • Limit stimulation - as overstimulation can lead to agitation.

  • Do not argue, try to reason, move suddenly, restrain, rush or crowd - these actions will only increase agitation.

  • If agitation turns into physical aggression - walk away if you feel threatened, remove objects that can be used as a weapon, give the person space to cool off, approach slowly and from the front and use eye contact. If your physical safety is at jeopardy, it may be appropriate to call 911.

  • If agitation and/or aggression are common occurrences despite use of these tips - a medical professional should be consulted. Although medications are used as a last resort, there are some people with Alzheimer’s that require stabilizing medications. Your physician can help you determine if the use of medications are appropriate.

The Alzheimer’s Association is a great resource for anyone caring for a person with Alzheimer’s. For additional information and support, their 24/7 hotline number is 1-800-272-3900. Don’t forget to take care of yourself!

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Alzheimer’s Disease: Evaluating Driving Safety and Strategies to Prevent Driving

Driving is an act of independence that is difficult for anyone to give up. A diagnosis of Alzheimer’s does not mean that driving must cease, but it does mean that evaluation of safety must be done on an ongoing basis. A timely diagnosis allows for planning ahead, which permits the person with Alzheimer’s to be involved in decisions that will affect his/her future.

Conversations should begin early and involve family and close friends. Together, evaluation of safe driving and suitable options can be discussed. First and foremost, we must validate feelings associated with the loss of driving privileges. This is often the first major loss of independence that is followed by many other losses. Compassionate conversations should include desired transportation options, such as shifting of driving responsibilities to a trusted family member or friend and transportation services aimed to assist the elderly, as well as practical steps to take as the disease progresses. These steps could include placing a GPS monitor on the car, medical driving assessments or a driving contract. The Alzheimer’s Association has a contract that can be printed and signed, which can be found at: www.alz.org/documents_custom/driving_contract.pdf

Resistance in conversations about driving are common, as is resistance to enforcing actions that have been previously discussed. As the loved one/caregiver of someone with Alzheimer’s, evaluation of warning signs of unsafe driving will be necessary. These include:

  • Forgetting how to get to familiar places, including forgetfulness of how to get home: Those with Alzheimer’s tend to take the same route to familiar places, but when they cannot recall where to go, evidence shows the extent of damage to the brain may affect the ability to drive safely in general.

  • Poor decision making while driving: This can include changing lanes without an awareness of other drivers (also affected by changes in peripheral vision in advancing Alzheimer’s), driving noticeably slow or fast and failing to follow traffic signs and signals.

  • Confusion between the gas and brake pedal

  • Takes longer than usual for routine trips

  • Irrational anger while driving

Driving is a complex task that requires adequate peripheral vision, insight and good judgement and the ability to make quick decisions. If you believe someone in your care is not equipped with the skills to drive safely, there are a couple of things you can do:

  • Discuss you concerns with your loved one’s physician. Ask the physician to write a script (prescription) stating, “do not drive”. This may deter your loved one from driving.

  • The physician may also request a medical driving assessment through the Department of Motor Vehicles. The physician can also report an unsafe driver to the DMV, which can lead to suspension of driving privileges until further testing is completed. Any concerned citizen can file a report as well. Check with your local DMV on the process as it varies from state to state. If the physician is not comfortable with assisting, I would recommend consulting a Geriatrician or Neurologist.

  • Remove triggers: Seeing car keys or the vehicle itself can trigger a person with Alzheimer’s to want to drive. If possible, secure car keys in a concealed location. Additionally, if feasible, park the vehicle in a different location- down the street, at your home, wherever you deem safe. If that is not possible, disable the vehicle by removing the battery. Therapeutic fibbing may be needed. For example, if asked, “Where is my car”, you can state, “It is at the shop getting worked on”.

  • Arrange transportation. You could also ask for permission to drive so the person with Alzheimer’s feels as though you want to drive and are not doing so to take care of him/her.

  • Be supportive. A person with Alzheimer’s is giving a part of their independence away. He/she may feel angry or sad and need to know that you empathize with him/her.

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Alzheimer’s Disease: How to Manage Wandering

Wandering becomes a particularly challenging behavior, often occurring in the middle stages of Alzheimer’s disease; however, can occur at any stage of the disease. According to the Alzheimer’s Association, 60% of people with dementia will wander at some point over the course of their disease (2015). As with any behavior, the cause of wandering must first be evaluated. Those with Alzheimer’s wander for a variety of reasons, to include:

  • Medication - if wandering is a new behavior and a medication was recently started, consider the medication to be a contributing cause. This goes for any new behavior - evaluate new medications first.

  • Confusion - this can be related to lack of awareness to time and place, as well as difficulty recognizing people and objects. Sometimes a person with Alzheimer’s believes he/she is back in another time period and feel the need to go to work or go home.

  • Fear - living with Alzheimer’s can be confusing and scary. The perception of the world around them is overwhelming and difficult to understand. Fear can also come from inability to recognize people and places. Can you imagine waking up in a “strange place”, with people you do not know? I can only imagine how scary that would be.

  • Agitation - this can be caused by many factors, such as constipation, urinary issues, infection and pain. Agitation may also be caused by lack of stimulation or too much stimulation.

What to do? There are several techniques that can be used to assist with wandering behaviors:

  • Ensure all needs are met. If the behavior is due to a factor you can control, address what is causing discomfort. Once the issue is resolved, the behavior may resolve.

  • Reassure - A person with Alzheimer’s need to know that he/she is safe and that you are there to help. If the behavior is due to wanting to go home or go to work, validate feelings, explore the meaning and reassure. A therapeutic fib can go a long way. For example, your loved one insists that he/she needs to go home, even though he/she is already home. State that you understand the desire to go home, but you would like to stay one more night. Ask your loved one if he/she would be willing to stay with you.

  • Promote activity such as exercise and assisting around the home (folding laundry, organizing items, planting flowers).

  • Secure your home - try using deadbolts. Due to changes in peripheral vision, the person with Alzheimer’s generally will not look up or down to find a lock. For this reason, placing locks either higher or lower than normal vision can prove to be an effective method. You can also try to place a dark colored rug in front of the door. Changes in perceptual vision make a dark rug appear as a hole and a person with Alzheimer’s may avoid the door to “stay away from the hole”. Lastly, you can make the door blend in with the wall. Paint the door and doorknob the same color as the wall. A person with Alzheimer’s will not see a door because of a lack of perceptual vision.

  • Let your neighbors know that you are caring for a person with Alzheimer’s. Ask neighbors to call if they see your loved one outside alone. If wandering does occur, search immediately. According to the Alzheimer’s Association, “Ninety-four percent of people who wander are found within 1.5 miles of where they disappeared” (2015). Search the perimeter of the location your loved one went missing. Interestingly enough, most people who wander will wander in the same direction of their dominant hand.

  • Look into a GPS device such as Comfort Zone® or Comfort Zone Check-In®. For more information about these specific devices, visit the Alzheimer’s Association website at www.alz.org/care and enter the device name in the search box.

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Eating Difficulty with Alzheimer’s Disease

I consult on eating issues with Alzheimer’s disease on both sides of the spectrum. Some will tell me they cannot get their loved one to eat while others tell me their loved one cannot stop eating. In the middle stage of Alzheimer’s disease, the area of the brain that controls hunger (hypothalamus) is damaged. As a result, issues with hunger and eating can occur.

Generally, earlier in the middle stage, the person with Alzheimer’s eats quite a bit. This is partially due to forgetfulness because he/she cannot remember their last meal. Additionally the part of the brain that allows the feeling of fullness is not working well. I cared for a gentleman in a facility setting who woke up in the morning and asked for breakfast right away. He would eat a full meal: pancakes, bacon, eggs and toast. He would then state he was tired and wanted to lay down. He would sleep for about an hour and get up and ask for breakfast again. He couldn’t remember that he already ate breakfast and he had the feeling of hunger. What do you think I did? I took him to the kitchen and gave him breakfast. He probably ate 2 of every meal of the day in addition to snacks.

What about weight gain? Weight gain is not as bad as it seems. Later in the disease process, a person with Alzheimer’s loses interest in eating and will begin to lose weight. Putting on extra pounds proves beneficial when the weight loss begins.

On the other side of the spectrum, I have heard many people comment that they cannot get their loved one to eat healthy meals or intake is significantly decreased. It is typical as the disease progresses for appetite to subside. Here are a couple of tips:

  • Have a physician check medications to ensure there are no medications that can cause nausea or decreased appetite. There are also appetite stimulants; however the use of these medications may be of only short term benefit and of course come with possible side effects.

  • Ensure dental issues are not the cause. Dental issues and loose dentures can lead to pain and subsequent decreased intake.

  • Keep distractions to a minimum; make the environment calm and inviting.

  • Only provide utensils that need to be used for the particular meal, as to avoid confusion. Use finger foods when possible.

  • Serve larger meals in the morning; encourage snacking throughout the day.

  • Make high caloric shakes and add protein. Make the shake with ingredients that are enjoyable to your loved one (such as using ice cream or adding fruit).

Lastly, think about how you ate when you were a child. If you were anything like me, you wanted dessert all day. Those with Alzheimer’s tend to have a sweet tooth and will generally eat anything sweet. Use this to your advantage. Some people sprinkle sugar over their loved ones food… he/she tastes the sweetness of the food and will eat. I have heard of other people using chocolate syrup. If diabetes is an issue, use an artificial sweetener. I know it sounds gross, but it works. Give it a try; you may be pleasantly surprised.

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Alzheimer’s Disease: Conquer the Bathing Battle

One of the biggest challenges caregivers of those with Alzheimer’s disease face surrounds bathing. I have heard many stories about failed attempts at bathing and understand the stress it causes. Fortunately, there are tactics that can be used to assist with this challenging task and I am going to share them with you!

If you haven’t read my prior blog on the Theory of Retrogenesis, I recommend you to check it out so this blog makes sense. As mentioned previously, a person in the middle stage of Alzheimer’s is at a cognitive level of a 4 year old, deteriorating to a cognitive capacity of a 2 year old. Let’s first look at how a child is bathed. Most kids run as soon as they hear the word “bath”. With some coaxing we can get the child to get in the bath, but we first ensure a safe, comfortable and fun environment. My parents used to persuade my brother and I will an Otter Pop, which usually did the trick. I remember bathing my daughter when she was a child. I would make sure the water was the right temperature for comfort, make sure I had plenty of bubbles and placed toys in the water. With some distraction, I could get her cleaned up in no time and we could move on with our day.

A person in the middle stage of Alzheimer’s needs a few considerations when it comes to bathing:

  1. With a cognitive level of a 2-4 year old, bathing can be scary. We don’t put a child with the same cognitive level in the shower, because it is frightening. For this reason, we must consider methods of bathing that is less frightening and comfortable.

  2. By the time a person with Alzheimer’s is in the middle stage, a part of the brain known as the hypothalamus has been affected. The hypothalamus is our thermostat; it regulates our body temperature. Since this part of the brain is affected, a person with Alzheimer’s is generally cold.

With that in mind, the following are tactics that can promote successful bathing:

  • Prepare: Ensure the temperature of the bathroom is comfortable for the person with Alzheimer’s. Keep in mind, this may not be a comfortable temperature for you. Run the water so the temperature is warm, but obviously not too warm. Get all necessary items in place such as soap (preferably a scent that the person has always enjoyed), robe, wash clothes and towels.

  • Promote dignity: A person with Alzheimer’s needs to feel safe and comfortable when taking off their clothes. Can you imagine if a person you didn’t recognize told you to take off your clothes and to get into the shower? You would probably feel scared and insecure. The person with Alzheimer’s may not remember who you are at the moment. If he/she needs you to hold up a towel while transferring, do that. Whatever is needed to make the situation less awkward is best.

  • Have the right equipment and promote independence: I would recommend getting a shower chair, non-slip mats, grab bars and a removable shower head. Remove the shower head and allow the person to run the water over themselves if they are able. If they are not able, ensure you show him/her the shower head and let him/her know what you are going to do. Allow the person as much independence during the shower. If there is a fear of water, use a hand towel to get the hair wet and to remove shampoo. It is also ok for the person to take a bath, but first ensure that it is a safe option. If the person has difficulty getting in and out of the tub, having them sit down in the tub may be unsafe.

  • Make the experience as enjoyable as possible: Rub lotion on their body, massage their back or wherever they like to be massaged, use pleasant aromas, place a robe on after the shower to keep him/her from getting cold, style hair, paint nails… I could go on, but you get the point.

  • Do NOT force the issue: If the person tells you “no” to a shower, do not argue. Simply walk away and try a different approach 5 minutes later. The person with Alzheimer’s most likely will not remember that you just asked him/her about a shower. Make it sound fun. If all else fails, give him/her something to eat. A person with Alzheimer’s can only focus on 1 task at a time. Just like my parents gave me an Otter Pop, give him/her a snack he/she enjoys and can have in the shower. The person may be a little more willing to do what you want if he/she has a sweet snack to concentrate on.

I hope these tactics help you to be successful with bathing. If you are encountering other challenging behaviors, send me a message. I will continue my blogs on Alzheimer’s based on your needs. How can I help?

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Middle Stage Alzheimer’s Disease: The Why’s and What’s of Challenging Behaviors

The middle stage of Alzheimer’s disease is often the longest stage of the disease process, lasting anywhere from 2-10 years. During this stage the cells in the occipital, temporal and parietal lobes are not able to communicate with other cells. Associated symptoms include irrational emotions, fear, anger, visual recognition difficulty, inability to control social behavior, less concern of appearance and difficulty initiating actions. Consequently, challenging behaviors are prominent and are a contributing source of caregiver stress.

Using the Theory of Retrogenesis, the cognitive level of an individual in middle Alzheimer’s is that of a 4 year old, regressing to a 2 year old. To put things into perspective, let’s first think about what a 2-4 year old experiences as they are learning and growing. Some typical positive indicators of cognitive development include increased vocabulary, urinary and bowel continence (potty training), walking independently (and probably running) and gaining independence of self-care activities (dressing, bathing, grooming). Anyone who has raised a child knows the importance of structure, consistency and a lot of patience. We also know that a 2-4 year old lacks concentration, can have erratic emotions, are irrational in thought processes and display negative actions when things don’t go quite right. In middle stage Alzheimer’s, the areas of the brain responsible for the development of a 2-4 year old are becoming damaged and eventually are not functioning in a meaningful way. This means that the person with middle stage Alzheimer’s will exhibit some of the same characteristics of a 2-4 year old.

It is not uncommon for an individual in middle stage Alzheimer’s to exhibit irrational emotions (crying for no particular reason), become upset when someone tries to help with personal care, or even punch, kick and spit. When faced with these challenges, we should treat our patient/loved one with the same kindness that we would treat a child with the same cognitive capacity. If your two year old is crying, what would you do? If your two year old is kicking and screaming, what would you do? I highly doubt your answer would be to administer psychotropic medications, but unfortunately, that is what is being done to people with Alzheimer’s every day. I think your answer would be to hold a crying child and assure them that they are safe or allow a child to scream and kick in their room while they get the behavior out of their system. It is reasonable to hold the hand of your patient/loved one who is crying and assure them that you are there with them and that they are safe. It is also reasonable to allow a person with Alzheimer’s who is screaming or fighting to be alone (in a safe place) while they get it out of their system. One of the advantages of caring for a person with Alzheimer’s is their memory span is only about 5 minutes long. It gives us as caregivers a chance to hit the reset button and try to approach them in a different way.

When faced with challenging behaviors, it is best to first determine the cause of the behavior. If an individual with Alzheimer’s lacks the ability to communicate effectively, he/she will communicate in the only way he/she knows how to. It is our job to listen with all of our senses and put the pieces of the puzzle together. The number one reason for behaviors is the presence of pain. Think about it. Most elderly people have arthritis or another ailment that causes pain. If a caregiver stands the person up and transfers him/her abruptly, don’t you think there could be pain? The person with Alzheimer’s may hit the person transferring him/her, because that is the only way he/she can communicate pain. There are many other discomforts that can cause behaviors such as a full bladder, constipation, too much or too little stimulation and hunger.

Stay tuned for next week’s blog, which will address handling specific challenging behaviors. If you are dealing with a specific challenging behavior that you want guidance on, send me a message and I will address it in upcoming blogs. I look forward to hearing from you and being a part of your journey.

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Early Alzheimer’s: How to Approach Challenges

The early stage of Alzheimer’s disease generally lasts 2-4 years, although there can be great variances in the development of the disease. It is important to keep in mind that many of those diagnosed have been living with Alzheimer’s for several years and as a result are in late-early or middle stage upon diagnosis. You may ask why. An individual with early Alzheimer’s can present very well. The person may be well groomed, dress well and speak as though there is no cognitive impairment. The person with Alzheimer’s has generally learned how to compensate for his/her forgetfulness by providing information that is not accurate. For example, a person with Alzheimer’s goes to a doctor’s appointment looking to be in great health. The doctor asks, "What did you eat for breakfast?" The answer may be something like, "eggs, bacon and a piece of toast". Makes sense right? Except the person in this story forgot to eat breakfast and happens to recall a distant memory of eating eggs, bacon and toast as a normal breakfast for many years.

A person with early Alzheimer’s will fill in the blanks to ensure his/her story makes sense. For this reason, people with early Alzheimer’s are called "The Great Foolers". So when a doctor only spends 5 minutes with a patient and asks questions that allow their patient to fabricate a story, the doctor truly has no idea that there is a cognitive impairment. It is usually the family that notices changes and seeks help.

The behaviors seen in early Alzheimer’s are generally associated with the lack of ability to capture short term memories. This can lead to difficulty organizing and communicating thoughts, misplacing items and inability to learn new information. Additionally, it is common in early Alzheimer’s to begin having difficulty with problem solving, completing complex tasks and have personality changes.

There are several things you can do to facilitate a more comfortable environment.

  1. Simply the selection of items: Instead of asking what is wanted for breakfast, say, "Would you like pancakes or waffles for breakfast".

  2. Break down new activities in simple steps: Because new information cannot be stored, reminders of each step may be helpful.

  3. Establish routines: It is often helpful to create routines to provide structure. Routines include the flow what occurs prior to breakfast, in between meals and before bedtime. I highly recommend making toileting every few hours and drinking a small glass of water after each bathroom trip part of that routine. It is important to keep up routines, as deviating from them can cause confusion.

  4. Find out what the person likes and what they don’t like: I have a form that I use that has questions like "I like to be remembered for", "I am most proud of", "My favorite music is" and "Things I dislike include". The answers to these questions come from distant memories and can guide how to care for the person. These questions can also be answered by loved ones to provide even more insight.

  5. Avoid distractions: A person with Alzheimer’s can generally only focus on one activity at a time. Encouraging focus on more than one activity can cause anxiety. Allow the person to perform activities at a slow pace; be patient.

  6. Whatever you do… do not argue: As the ability to problem solve dissipates so does the ability to rationalize thoughts. If you are trying to rationalize with a person that does not have the capacity to rationalize, you will likely frustrate yourself. You will not win the argument; it is best to use your energy in more productive ways.

When determining the best tactic to use with a person with Alzheimer’s, I recommend using the Theory of Retrogenesis (discussed in previous blog). Cognitively, a person with early Alzheimer’s is 5-11 years old. What approach would you use with a child of that age? Again I stress, this in no way implies that a person with Alzheimer’s should be treated like a child. It is merely a method to be creative in your approach.

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Alzheimer’s Disease: A Different Perspective

I once heard, "If you have met one person with Alzheimer’s, you have met one person with Alzheimer’s". No two people with Alzheimer’s disease have the exact same signs, symptoms and disease progression. For this reason, it would be difficult to develop generalizations when dealing with challenging behaviors. I have found the Theory of Retrogenesis to be the most beneficial tool in determining approaches and techniques to handle even the most complex situations.

The Theory of Retrogenesis (back to birth) was developed by NYU professor, Dr. Barry Reisberg, who has researched cognitive impairment and subsequently published numerous articles over the past 35+ years. According to this theory, the brain degenerates in the reverse order that it developed from birth as Alzheimer’s disease progresses.

In Alzheimer’s disease, the hippocampus is the first structure that is affected. The hippocampus is responsible for the retention of short term memories and conversion of those memories into long term memories. With damage to this area, an individual with Alzheimer’s disease is unable to recall recent events and have significant difficulty with learning new information.

Let’s first think about the progression from birth to adolescence and cognitive indicators that signify expected brain development. During the first 1 ½ years of life, we would expect a newborn/infant to smile, hold their head up on their own, sit up, walk and begin to speak several words. As a toddler, ages 2-4, we would expect a child to become continent of bowel and bladder (potty training) and eventually learn the mechanics of toileting (flush the toilet, wash hands). A toddler also begins to speak more words, learns to dress self and begin performing activities of daily living independently. From toddler to adolescence, ages 5-11, a child learns to choose the right clothing for the right situation (occasion and weather), become fully independent of activities of daily living, speak a rich vocabulary, engage in social activities and learn about money (how much things cost and saving/spending money).

The Theory of Retrogenesis conceives that a person with Alzheimer’s disease will experience regression of these same cognitive indicators in the reverse order, which would occur as the brain is degenerating. Before I explain further, I want to emphasize that these classifications are not to imply that an individual with Alzheimer’s disease is childlike or should be treated like a child.

An individual with early Alzheimer’s may have difficulty finding the right words, isolate from others, have difficulty managing money, begin having difficulty with activities of daily living and eventually have difficulty choosing the right clothing or the right sequence of dressing (may put a bra over their shirt). Cognitively speaking, a person with early Alzheimer’s is similar to that of a 5-11 year old. As the disease progresses into middle stage Alzheimer’s, the individual may have difficulty with dressing, forget the mechanics of toileting, speak fewer words, having difficulty with ambulating independently and have episodes of incontinence. Cognitively speaking, an individual with middle stage Alzheimer’s is similar to that of a 2-4 year old. Further progression into late stage Alzheimer’s leads to inability to ambulate independently, incontinence and inability to speak more than several words. In end stage Alzheimer’s, the individual is unable to sit up without assistance, unable to hold his/her head up and unable to smile. Cognitively speaking, an individual with late to end stage Alzheimer’s is that of a 1 ½ year old to newborn.

Keeping the Theory of Retrogenesis in mind, what techniques would you use with an 11 year old, or 3 year old or even an infant? Imagine your infant is crying and cannot be consoled. What would you do? I would imagine you would investigate further to determine why your infant is crying. Your infant may cry because he/she is hungry, needs a diaper change or maybe even have an ear infection. Your infant will communicate with you that something is wrong in the only way he/she knows how to. An individual with Alzheimer’s will also communicate the only way he/she knows how to, which could include crying, screaming, punching, kicking and spitting. We must investigate the cause of distress and act in the same kind manner we would for someone who is at the same cognitive level. Again, this does not mean that we talk to an individual with Alzheimer’s disease like a child or treat them like a child.

Continuing with our blog on Alzheimer’s disease, we will expand on the Theory of Retrogenesis to include difficulties with care such as getting out of the house, taking medications and drinking water.

Reisberg, B. (1984). Alzheimer’s disease: Stages of cognitive decline. American Journal of Nursing, 84: 225.

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Alzheimer’s Disease: Exploration of the Brain

With Alzheimer’s disease being the most common type of dementia, the focus of our dementia series will be on Alzheimer’s. Furthermore, changes in the brain and therapeutic interventions for other dementias have some correlating features with Alzheimer’s disease.

Alzheimer’s disease develops as the result of the accumulation of amyloid plaques between nerve cells and neurofibrillary tangles inside nerve cells. These abnormal structures interfere with the transmission of messages between neurons, which leads to nerve cell death. As nerve cells die, the brain shrinks and as a result, functions of the brain are lost. The loss of brain function is progressive, occurring as different areas of the brain are affected.

In Alzheimer’s disease, the hippocampus is the first structure that is affected. The hippocampus is responsible for the retention of short term memories and conversion of those memories into long term memories. With damage to this area, an individual with Alzheimer’s disease is unable to recall recent events and have significant difficulty with learning new information.

As the disease progresses, the parietal lobe is affected, which is responsible for spatial processing, ability to navigate, time awareness and language. With damage to this area, processes such as orientation to time, ability to communicate and the ability to process information in terms of movement is altered.

Damage extends to the temporal lobe, which is responsible for processing sensory input, visual memories and language comprehension. Damage to this area can lead to the inability to identify common items, impairment in the ability to recognize familiar faces and difficulty with the reception of verbal and written communication.

As the disease progresses, the occipital lobe is affected, which is responsible for vision, visual perception, color differentiation and motion perception. Damage to this area can lead to difficulty with vision which may include blindness, inability to distinguish how far an object is and inability to use peripheral vision. For this reason, an individual with Alzheimer’s may perceive a black rug as a hole, as well as become fearful when approached from the side. Since we are on the topic, using a black rug in front of a door may keep an individual with Alzheimer’s away from the door because they see a hole in front of the door. Additionally, putting locks either high or low prevents the individual with Alzheimer’s from seeing the locks, as they only see what is right in front of them. An individual with Alzheimer’s should be approached from the front to avoid fearful interactions.

Later in the disease process, the frontal lobe, motor cortex and sensory cortex shrink and further deficits are noted. The frontal lobe is responsible for executive thinking, abstract thinking and control of social behavior. With damage to this area, an individual with Alzheimer’s becomes unconcerned with appearance, have difficulty initiating actions, become brutally honest, lose the ability to problem solve and use rational thought and have socially inappropriate behavior. The cortex is responsible for continence, ability to perform activities of daily living, swallowing and ambulation. Damage to this area leads to difficulty with ambulation (stance widens initially, later the individual is no longer to ambulate without assistance), incontinence of bladder and bowel, inability to perform activities of daily living without assistance and difficulty swallowing.

Understanding the changes in the brain gives guidance on what to expect as the disease progresses. Although all of the elements discussed is this blog are devastating, there are useful strategies in caring for someone with Alzheimer’s based on the level of damage in the brain. Stay tuned next week… We will begin discussing how to manage changes and difficult behaviors.

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What is Dementia?

Have you ever heard someone say, “My mom has a little dementia”? What does that mean? Dementia is a very broad term that is used to characterize a set of symptoms, such as memory impairment, difficulty with communication and decreased ability to use logic and reasoning. Dementia is often referred to as an “umbrella term”, in which dementia is an overarching concept with different specific subtypes. Nobody has “a little dementia”; dementia is either present or not. Dementia may be reversible, such as in the case of various imbalances in the body, depression, thyroid issues and several other factors. These reversible causes should be ruled out first. Upon the diagnosis of a non-reversible dementia it is imperative to investigate what kind of dementia your loved one has to allow for the best treatment options. There currently are no cures for non-reversible dementia; however being equipped with accurate information allows for planning for the future.

The most common type of dementia is Alzheimer’s disease, which accounts for approximately 60-80% of all dementias. Early in the disease process, the affected person demonstrates difficulty with short term memory, withdrawal from normal activities and depression. Individuals with early Alzheimer’s are referred to as “The Great Foolers” because of their ability to dress and act the part, but they are doing everything possible to prevent others from realizing their deficits. If you spend more than 5 minutes with someone with early Alzheimer’s, you will see that they are hiding a secret. As the disease progresses, the affected person has difficulty understanding the use of common items, forget how to complete ordinary tasks (such as putting a shirt on), become easily frustrated or emotional and exhibits impaired judgment and cognition. In later stages, the affected person needs assistance with most activities of daily living, are unable to ambulate independently, have limited speech, have a poor appetite with significant weight loss and have bladder and bowel incontinence.

Vascular dementia and Lewy body dementia are considered to be the second most common types of dementia, each accounting for approximately 10% of all dementias. Vascular dementia is a result of a lack of oxygen supply to the brain, generally occurring as a result of a stroke or multiple mini-strokes. Vascular dementia often presents like Alzheimer’s disease with more specific characteristics being associated with the part of the brain that is affected.

Lewy body dementia is the result of Lewy bodies that are found in the brain. Lewy body dementia is closely linked to Parkinson’s disease, as those with Parkinson’s disease also have Lewy bodies present. As such, symptoms of Lewy body dementia can involve movement disorders often seen with Parkinson’s disease in addition to variable cognition (alternating cycles of confusion and orientation), hallucinations, delusions, sleep disorders and memory impairment. Because of the overlap of symptoms, diagnosis of Lewy body dementia versus Parkinson’s disease is determined by examination of the initial symptoms. If symptoms of dementia occurs prior to a movement disorder, the diagnosis is generally Lewy body dementia. If a movement disorder occurs first and dementia occurs later in the disease, Parkinson’s disease is likely the cause. An individual with Parkinson’s disease is not guaranteed to get dementia, but they are at a much higher risk than the general population. Other common dementias include frontotemporal dementia, normal pressure hydrocephalus, mixed dementia, alcohol induced dementia, Creutzfeldt-Jakob dementia and Huntington’s disease.

Obtaining a definitive diagnosis can be a time consuming process, as being present at each physician appointment is advisable and follow-up is essential. Hiring a Geriatric Care Manager (GCM) is of great benefit during this time, as a GCM is able to attend physician appointments, communicate findings with you and schedule necessary follow-up. A GCM specializes in advocating for your loved. Not all GCMs are created equal, so it is best to hire a GCM that specializes in dementia and understands the process.

If you have any questions or need expert advice in caring for an older adult with dementia, email me directly at mjohnson@seniorcmsolutions.com. I look forward to hearing from you!

Stay tuned for future blogs for more in-depth information on dementia and tips for caring for those affected by dementia.



Normal Aging Versus Dementia

It was once believed that “a touch of dementia” was a normal part of aging. There is still the misconception that the onset of forgetfulness indicates that dementia is present. Forgetfulness as one ages does not necessarily signify the presence of dementia. So what is normal? It is not uncommon for someone to forget where they left their keys and later can remember where their keys are after tracing back their steps. If the keys cannot be found because they are in an unconventional area such as the refrigerator, dementia should be considered as the culprit.

Normal memory loss involves forgetting parts of an experience, which is often recalled later. With dementia, an entire experience is forgotten and generally cannot be recalled later. Another common characteristic is forgetfulness of recent events or information. For example, a person with dementia may ask for breakfast 15 minutes after they ate breakfast. The individual has no memory of eating breakfast and generally will not remember that they did eat. We will discuss the benefits of this in later blogs (so stay tuned).

Other characteristics of dementia include challenges in planning or solving problems, difficult completing familiar tasks, confusion with time or place, increased difficulty understanding visual images and surroundings, new problems with speaking or writing, poor judgment, withdrawal from activities and change in mood and personality.

If dementia is suspected, an appointment should be scheduled with a primary care physician to rule out any reversible causes of dementia. There currently is no cure for non-reversible dementia, which is why early diagnosis is important to allow more time to plan for the future. Dementia is a progressive disease; decisions about care, living arrangements, safety, and financial and legal matters should be discussed prior to deterioration of mental capacity. This allows the individual diagnosed with dementia to be empowered to participate in decisions that will ultimately affect the rest of their life.



January is National Glaucoma Awareness Month

Glaucoma is estimated to affect over 2 million people in the United States alone and is the second leading cause of blindness in the world. In the U.S. more than 120,000 people are blind as a result of glaucoma. Risk factors include race (African Americans are more likely to get glaucoma), age (people over the age of 60), family history of glaucoma, diabetes and severe near-sightedness.

It is estimated that half of the 2 million people believed to have glaucoma in the U.S. are not aware that they have the disease. This is due to glaucoma’s silent symptoms that sneak up on those affected quite rapidly. Vision is generally affected first peripherally; people generally recognize visual deficits once the disease has advanced past this stage. Treatment is most effective when glaucoma is detected early. There currently is no cure for glaucoma.

There are several tests that are important to initiate early, such as visual field analysis, inner eye pressure testing and examination of the optic nerve through dilation of the eye. At a minimum, you should have your eyes tested every 2-4 years if you are under the age of 40, every 1-3 years if you are between the ages of 40-54, every 1-2 years if you are between the ages of 55-64 and every 6-12 months if you are over the age of 65. Testing and early detection are the cornerstone for treatment. Treatment may include medications and surgical interventions, each having side effects that you should be aware of prior to starting any treatment. Several research projects are underway to hopefully find a cure for this debilitating disease.

Information obtained from and further information can be found at www.glaucoma.com



What is a Geriatric Care Manager?

I am often asked, “What is a Geriatric Care Manager (GCM)?” or get blank stares when I tell people that I am a GCM. Although GCMs have been practicing their craft for many years, even prior to the establishment of the National Association of Private Geriatric Care Managers in 1985, many individuals in the community have never heard of a GCM or have limited knowledge of the many benefits of hiring a GCM.

According to the National Association of Professional Geriatric Care Managers (NAPGCM), a GCM is “a health and human services specialist who acts as a guide and advocate for families caring for older relatives…” (2015). What does that mean?

A GCM is called upon during times of crisis, frustration and despair to provide a thorough, holistic assessment and develop a care plan specific to the older person’s issues. The goal of a GCM is to ensure safety, promote independence in the least restrictive environment while improving quality of life for the elderly and provide peace of mind for their loved ones. GCMs provide a wide variety of services to include setting up home care, medical management, arrange social activities/interactions, assist with referrals for legal and financial matters, communication between care providers and loved ones, assist with transition to a different level of care and provide interventions to ensure safety. GCMs monitor the client’s care plan and make adjustments as needed. GCMs are able to provide education, support and advocacy throughout the continuum of care.

When is the right time to hire a GCM? GCMs are beneficial to older clients that have limited support, clients with multiple hospitalizations or physician visits, those who may be unsafe in their current living situation, family members who live at a distance and find it increasingly difficult to manage care needs, family is not in agreement of care needs, client is confused and has limited decision making capacity or clients and their loved ones that find the healthcare system to be confusing and do not know where to turn.

Anyone can claim to be a GCM; however a professional Geriatric Care Manager is one that is a member of the NAPGCM, as this association has stringent guidelines in terms of education, expertise and certification.

If you have any questions or want to know more about hiring a GCM or becoming a GCM, feel free to email me at mjohnson@seniorcmsolutions.com. I look forward to hearing from you!



Coping With Loss During the Holiday Season

The holiday season is filled with joyous music, anticipation of family tradition and cheerful greetings. “The most wonderful time of the year” can bring feelings of grief that are more intense and especially painful following the loss of a loved one. It is important to remember that your grief experience belongs to you and only you. Feelings of anger, guilt, depression and loneliness are normal responses to loss. There is no rule book on how to grieve and as such, you must grieve in a way that feels right to you. There are several methods to assist with coping with loss during the holiday season:

  1. Be kind to yourself and accept your limitations: Allow yourself to enjoy the holidays by choosing how you want to spend your time. The holidays can be demanding and overwhelming. Decide what you want to do and what you do not want to do and talk to your family about your desires. Prioritize what you want to accomplish during the holiday season.

  2. Traditions: Continuing a family tradition may provide a sense of comfort for some and can cause more distress for others. Choose what traditions you want to keep and create new traditions where you see fit. Changing surroundings or traditions may decrease the stress that comes along with the holidays.

  3. Socialize: The holiday season may tempt you to isolate yourself; being around others can be therapeutic. Choose to spend your time with people that are accepting of where you are with your grieving. Support groups can also be a great means of relatable support.

  4. Ask for and accept help: Your loved ones may be searching for ways to be a part of your journey. Allow them to support you, especially in times of low energy. Grief can consume your energy; allowing others to help you grants you the opportunity to spend your energy on what is likely to give you a sense of peace.

  5. Be aware of your feelings: Even years following the death of a loved one, you may experience grief around the holidays similar to that felt immediately following the death event. Acknowledge your feelings and understand that your feelings are a normal part of the grieving process. Do not be ashamed to express and discuss your emotions with those you trust.

No one can tell you how to grieve or how long this process should take. You are entitled to grieve as long as you feel is necessary. I wish you a peaceful holiday.