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ElderCare Solutions of MI

Tag: Alzheimer’s

Dementia…that single word carries with it a tremendous amount of stigma.  But it is the second most common diagnosis given to older adults. And perhaps the most difficult to accept.  Once that label has been given, people never forget it. As this happened to several of our client this week, I wanted to address two of the questions we are asked most often after someone receives a Dementia diagnosis starting with “What exactly is Dementia and how is it diagnosed?” 

Dementia is an umbrella category that serves as a catch all for different types of cognitive disorders, ranging from simple short or long term memory loss to more specific diagnoses including Alzheimer’s disease.  Dementia diagnoses are usually made by combining someone’s history and experiences with some type of testing, so that objective evidence and observed functioning together form the basis for the diagnosis.  MRIs or other brain scans are helpful to identify vascular dementia and rule out physical causes for cognitive difficulties such as brain tumors.  More extensive neurological and psychological testing are available and can provide objective measures of cognitive abilities and identify specific areas of strengths as well as deficits.

Cognitive screening tools however, are available to anyone regardless of history of symptoms, and are very low cost.  Screening tools are designed to help people identify whether or not a more thorough evaluation is necessary, and scores are broken down into three distinct categories of “Normal, Mild Cognitive Impairment (MCI), or Dementia”.  Cognitive screening is a great place to start, but it is important to remember that the results may not be conclusive.  For example, if someone’s score results in a determination of MCI, it would be important to follow up with more in-depth testing.  There have been many instances of people who are highly intelligent testing as MCI when further testing indicates Alzheimer’s disease. Their intelligence allows them to compensate for their cognitive deficits on the screening tool, but cannot be sustained through more extensive testing.

Which brings us to another frequently asked question: “Why is it important to be screened or tested?”  That’s an individual decision, but unfortunately at this time there is no cure for Dementia.  However, there are several medications that are believed to slow down the progression of the disease and help keep people living with more mild to moderate forms rather than severe.  If that is the case then starting treatment as early as possible is important to help preserve cognitive functioning.  The decision to use medication is of course an individual one, and needs to be made in consultation with a doctor who can explain the benefits as well as possible side effects.

Counting my blessings while I still can,

Lynn

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Have you ever walked out of a parking lot and had to think for a moment because you weren’t sure where you had parked your car?  Or searched the house because you couldn’t find your keys? I know most of us have.  And for a second we usually joke about losing our memories or getting older, but the reality is that most of us lead very busy lives, and we don’t always pay enough attention to the routine tasks we do each day, and occasionally have difficulty remembering where we left our keys (or car).  And that’s perfectly normal, especially as we age.  So how do you distinguish when your level of forgetting is no longer what would be considered normal?  And how difficult must it be to accept that?

Generally speaking, when memory loss or confusion is severe enough to interfere with someone’s ability to work and maintain a social life, it is no longer considered normal age related cognitive changes.  Instead that’s probably the time to consult a neurologist or geriatrician for a closer look.  But the fact that some of these things occasionally happen to all of us, ironically feeds denial, both on the part of the person living with dementia, and their family members.  Luckily, education and support are available, both one -on-one and support groups.  Support groups are offered through the Alzheimer’s Association, as well as through many memory care communities and adult day treatment programs.

In the meantime, if you would like to better understand how it feels to be someone living with dementia, pick up a copy of Still Alice, by Lisa Genova.  It is a really quick read that paints quite a vivid picture.

Pulling out my copy,

Lynn

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While many of you were hopefully enjoying some fun in the sun on this 4th of July weekend, my family’s weekend was bustling with indoor activity because my much loved niece got married on Saturday.  The festivities spilled over into the entire weekend.  It was absolutely heartwarming to see so many familiar faces again, all in one room.  And as we made our way from table to table, gathering snippets of conversation as we went, I think we were all experiencing a myriad of thoughts and feelings.  Some heartwarming, “Where has the time gone?”, others silly “Look who asked who to dance…”, but I was surprised at the direction my own thoughts were taking.

I was struck by something altogether unexpected, namely the fact that there were many older adults in the room from both the bride and groom’s sides of the family, and absolutely none of them appeared to have any type of dementia!  Given the work that I do, all too often I see the way dementia robs older adults of their independence, their relationships, and often their peace of mind.  I see it so often that somewhere along the line a part of me began to accept it as a consequence of growing older.  But seeing this vital, thriving group of seniors actively engaged and enjoying this phase of life, reminded me that it doesn’t have to be that way.  Whether the causes are due to genes, lifestyle, luck or a combination of factors, clearly the quality of life implications are impossible to overstate, and deserve our time and attention, as well as ways to prevent and treat this challenging disease.

Relishing my memories,

Lynn

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High summer temperatures and beautiful sunshine create an irresistible temptation to explore and enjoy what we have all waited so long for. However, it can also pose a significant increased risk for wandering, which is defined by the Alzheimer’s Association as “a behavior of people with dementia who move about in ways that may appear aimless, but which are often purposeful.” Up to 69 percent of those with dementia will wander.

            According to Lisa Gardener, Family Service Program Coordinator of the Alzheimer’s Association , Greater Michigan Chapter, while wandering can be dangerous and life threatening, wandering within safe conditions can actually be beneficial. Safe wandering can occur when precautions are taken and boundaries are set to ensure the safety of the individual with memory loss.  There are times when attempting to stop the wandering behavior creates more agitation or anxiety in the person with memory loss. It’s important to look at the benefits of safe wandering. Here are some benefits to safe wandering that are sometimes taken for granted:

  • Provides physical exercise
  • Promotes a sense of freedom and independence
  • Offers a social opportunity between the caregiver and person with memory loss
  • Promotes a sense of independence for the individual with dementia
  • Reduces boredom
  • Can be calming for a person with memory loss
  • May help assist in calming an individual with memory loss who is upset

 Here are some tips to aid an individual with memory loss with safe wandering:

  • Provide a safe environment for them to walk in (example- an enclosed courtyard or hallway)
  • Look into in home devices that can help alert the caregiver when the person with memory loss is trying to leave a safe environment
  • Offer to help them find what they are looking for
  • Offer to take them for a drive, or go be a companion for a walk,  if they insist on leaving the premises
  • Call another friend or family member to come over and assist if needed
  • Find a friend or family member to go visit during these times, which can help in redirecting the individual with memory loss
  • Once the individual with memory loss has been reassured, find a way to redirect their attention

Wandering becomes a problem when it puts the person with memory loss or other people in a life threatening situation, and it’s important to be prepared if the situation ever arises. The Alzheimer’s Association has a Medic Alert + Safe Return program which has a 98.9 percent success rate of finding a lost individual within the first 24 Hours. If you would like more information regarding the Medic Alert + Safe Return/ Comfort Zone program, call their 24 Hour Harry L. Nelson Helpline at 1-800-272-3900, or visit www.alz.org. Alternatively, several personal emergency response systems have a GPS feature which can be helpful locating someone who is wandering.  Whichever option you choose, keeping your loved one safe is what matters.

Going for a walk,

Lynn

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As Geriatric Care Managers we often talk about helping improve quality of life for our clients, many of whom have dementia.  And often times this involves providing companionship and offering choices.  But yesterday, while attending a networking meeting for professionals who work with seniors, I heard about a program that is a tangible quality of life enhancement and I couldn’t wait to tell you about it!

The Detroit Institute of Arts, in partnership with the Alzheimer’s Association, is offering a free 6 week program called Minds on Art for people living with Alzheimer’s and their companions.  The program will offer the opportunity to engage socially, cognitively and artistically, and will be held at the DIA.  The format includes a one hour gallery tour and discussion followed by a short break, and then time in the art studio.  The program will be led by DIA staff and volunteers, and a member of the Alzheimer’s Association staff will be there as well.  This program struck a powerful chord for me because I have worked with several clients living with dementia, for whom artistic expression remains a source of joy, long after the onset of dementia.

The sessions will be offered on Mondays for people in the mid-stage of dementia and their companions, and on Tuesdays for those in the early stages.  The 6 week courses begin in April and run through the end of the year, however space will be limited as these are very small group activities.  To register or for more information please contact Jean Barnas at (800)272-3900 or jbarnas@alz.org.

Calling my clients with the news,

Lynn

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I said good-bye to my beloved grandmother, Nannie, as I called her, in late November 2008. Alzheimer’s disease had ravaged her brain and taken away the grandmother I knew as a child. She was diagnosed in 2001 and steadily began to decline. Gone was the vibrant, eccentric gourmet cook, artist, and world-traveler, among other talents. She no longer helped me make cookies, sent me hand-drawn cards, or went on safari in Africa. She now needed to be reminded who I was, what food she was eating, how to get dressed.

She moved in with us and I watched as my mother had to essentially care for a second child. It must have been difficult, having one child going off to college and not getting an empty nest as she had been expecting. It was challenging for all four of us (My parents, my grandmother, and I) as we all had our roles constantly redefined, changed, and renamed. I was no longer granddaughter, I was big sister. My mother was no longer a daughter; she was a mother to her mother. My father was just a visitor. Even the dog played along: he was now the cat.

Within these roles, our responsibilities and expectations also changed. We no longer ventured far from home. I would have to “baby-sit” my grandmother and make sure she didn’t try and walk down the stairs for fear of a fall. My grandmother would set the table; someone else would reset it with the proper dishes and silverware for each setting. We all learned patience and creativity as we tried to keep her occupied and happy. We repeated ourselves often. The dog learned that he would have to go outside to do his business every 15 minutes because Nannie would forget she had already let him out.

As her disease progressed, it became obvious that she was no longer safe in our home. My parents woke up in the middle of the night to find her outside in her nightgown in December waiting for the bus to “go home.” With much pain and regret, my mother made the decision to place her into an assisted living unit. Faithfully, she visited my grandmother nearly every day. For over three years, my grandmother was in this facility before she went into hospice.

A few days before she was moved to hospice, she was having a particularly good day. I had taken a leave of absence from work so that I could be with my family and spend time with my grandmother, so I was sitting with her in the common room when she had a completely lucid moment, looked right at me and said, “I love you, Jennie.”

I think about this moment often. It is something I hold onto, for in all those grey, dark days where Alzheimer’s had taken over, this is a memory that shines like sunlight. It chases away all those negative thoughts and is how I like to remember Nannie in those last few weeks leading up to her death.

Jennifer Simms-Coffey

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Hospice…the word alone is enough to conjure up frightening images for many people.  But hospice services can bring relief from pain and extra support for older adults and their families, at no out-of-pocket cost because hospice services are covered by Medicare.  Those of you who are regular readers of this blog already know that, because it is a topic I feel passionately about! 

But what you may not know is that dementia is a diagnosis that can qualify someone to receive hospice services.  Medicare has a specific set of criteria that must be met in order for someone to be certified hospice eligible.  Dementia criteria include the following:

  • Unable to walk without assistance
  • Unable to dress without assistance
  • Unable to bathe without assistance
  • Constant or intermittent incontinence
  • No consistently meaningful verbal communication
  • Significant weight loss in the past year

As you can see from the criteria, someone with mild to moderate dementia would not qualify, but someone living with the advanced stages of the disease would likely be eligible.   And hospice can truly make a difference for people at this stage, most often by adjusting medications and providing weekly nurse visits for oversight.  Many times these slight medication adjustments can help someone be able to speak a few words, who had seemingly lost that ability, or help with behavioral issues that arise from frustration.

As a friend of mine who works in the hospice field is always saying “Even when there’s no cure, there’s hope.”

Lynn

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Almost everyone knows someone who is living with Alzheimer’s.  I will never forget the day when my great-aunt, my oldest living relative, looked me square in the face, and called me by my mother’s name. It was heartbreaking that she didn’t know who I was, and although I wanted to tell her it was me, I knew that even if I corrected her, it would do no good. 

This past spring, the Obama administration took a giant step toward progress by  developing  a National Alzheimer’s Plan, with the hope to prevent and effectively treat Alzheimer’s disease by 2025.   The crux of the plan begins with an investment of $156 million dollars to increase Alzheimer’s disease research,  and support people currently living with Alzheimer’s.

The details of the plan are many, and its mission and goals are specific.  But what it represents to so many of us can be conveyed in one simple word…Hope.

For more information on the details of the plan, visit http://aspe.hhs.gov/daltcp/napa/NatlPlan.shtml#intro

Remembering,

Lynn

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Do you have arthritis pain?  If so, is it in your hands or your knees?  Is it in your hip or your back?  What do you do on those days when the pain goes from bothersome to really bad?  Is Tylenol or Motrin your drug of choice, or do you need something stronger? 

If you’re like most people, annoying aches and pains become an accepted part of life as we get older.  But what would you do if you were unable to get your own pain medicine, and didn’t have the words to tell anyone that it hurt?  Unfortunately this is often the case for people living with advanced Alzheimer’s disease or other dementias.  Those lifelong aches and pains don’t go away when dementia sets in.  In fact, the nerves in our brains that sense pain are among the last to be effected by progressing dementia.

Pain can actually be mistaken as behavioral issues for people with advanced Alzheimer’s.  Carol Waarala, LMSW from Odyssey Hospice shared the following story during a recent presentation:

Imagine that you’re a resident in a skilled nursing facility.  During the night you rolled into the wall, banging your thin arm pretty hard.  It’s very painful when you wake up in the morning, but nobody saw it happen and you can’t find the words to explain.  So, when the caregiver comes into your room to help you get dressed, she tries to raise your arm, but it hurts, so you reflexively jerk it back.  She tries again, not understanding that you are in pain, and once again you pull your arm back.  As she continues to try to dress you, you push her away in an attempt to stop the pain.  From the outside, it looks as though you’re becoming uncooperative, or are displaying some sort of behavioral issue.

It’s important that all of us, geriatric care managers, nurses, physicians, aids, and family members be on the look out for indicators that someone is in pain.  Facial grimaces and repeated vocalizations are often signs. Hospice agencies have a wealth of knowledge about observable signs of pain, and can be a resource if you need more information.

Ever vigilant,

Lynn

 

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One of the decisions families struggle with the most is deciding their next step when  independent living is no longer enough to meet an older adult’s needs, especially an older adult who is living with Dementia. Where should they move to, an Assisted Living or a Memory Care community?

Unfortunately there is no one size fits all recommendation.  The line between the different types of senior living environments is blurring.  As more and more people choose to age in place, either for quality of life or economic reasons, the population of older adults is no longer as different in these communities as it once was.

Independent Senior communities were originally designed for reasonably healthy seniors who were looking to maintain their independent lifestyle without the burden of home ownership.  Additionally these communities offer a dining room, activities, hair salon and often times transportation services.  However, in recent years many older adults have chosen to remain in their independent living apartments as their health declines, adding “a la carte” supportive services where available from their building management, or bringing in their own private duty aides to assist them.

Assisted Living communities were designed for older adults who require supportive services for physical or slight cognitive difficulties.  They offer many more supportive services such as medication reminders, assistance with dressing, bathing and other activities of daily living. Additionally, older adults and their families always have the option to supplement the care available by hiring private duty caregivers.

A Memory Care community is designed to provide for the needs of older adults living with moderate to severe Dementia.  Most types of assistance are included in the daily rate, and the staff is specially trained to understand Dementia, particularly how to interact with people who are living with the disease.

The risk of moving someone who has Dementia is that the move itself will be disruptive and is likely to cause a decline in their cognitive abilities.  Therefore it is important to make the best choice for that individual in hopes of avoiding a second move later on.  Hallmarks that would suggest a Memory Care community may be better, include wandering, because Memory Care communities are generally locked, as well as having days and nights mixed up.  Often people with advancing Dementia will be awake at night.  Memory Care communities are aware of this phenomena and usually have some activities at night.

If these general guidelines aren’t enough to give you clear direction, consider contacting a Geriatric Care Manager.  They can assess an older adult’s individual situation, and help advise the family.

Here to listen,

Lynn

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