Nip Depression in the Bud: Warning Signs to Look For

By Mary Damiano

While caregivers are defined as the people taking care of those needing help, they sometimes overlook the fact that caregiving responsibilities can take a toll on their own health.

In addition to physical ailments, caregivers are at risk for depression. Depression can strike anyone, at any age. Caregivers need to be especially aware of depression because of the great load they carry. Many caregivers work at a full-time job and take care of a family in addition to their caregiving responsibilities. They often sacrifice their own health, well-being and social life in order to do everything that needs to be done.

One common denominator among caregivers is the desire and the belief that they must do everything themselves. Often, caregivers do not ask for help, opting instead to inadvertently play the part of the martyr. This leads the caregiver to become overwhelmed and an overwhelmed person is fertile ground for depression to dig in and take root.

The great strain caregivers face on a daily basis can lead to depression. One way to stop depression before it strikes is to be aware of the warning signs. According to the Administration on Aging, here are some red flags that depression might be creeping in:

  • Sad, discouraged mood
  • Persistent pessimism about the present, future and the past
  • Loss of interest in work, hobbies, social life and sex
  • Difficulty in making decisions
  • Lack of energy and feeling slowed down
  • Restlessness and irritability
  • Loss of appetite and loss of weight
  • Disturbed sleep, especially early morning waking
  • Depressive, gloomy or desolate dreams
  • Suicidal thoughts

If you feel yourself exhibiting these behaviors, do not discount them. They should be taken as seriously as you might treat a fever that won’t go away or a persistent cough.

Below are some expert tips on what caregivers in particular can do to stop depression before it gets out of control:

Talk regularly with family, friends, or mental health professionals— it is very important that you do not isolate yourself. Join a local support group, or find one online. Share your feelings so they don’t build up and escalate into problems.

Set limits— this can be hard for caregivers, because they are used to taking on everything that needs to be done. It’s okay to say no to taking on more than you can handle.

Eat nutritiously, exercise regularly and get enough sleep— this can be difficult because of the irregular schedules caregivers must keep. But think of it this way: your body and mind are machines, and they must be properly maintained in order to function at their best. Nutritious food, exercise and sleep are the things that fuel these machines. Just as you would not let your car run out of gas, don’t let your body run out of its fuel.

Let go of unrealistic expectations— caregivers often have unrealistic expectations of themselves, and therefore push themselves to meet these goals. Accept the fact that you can’t do everything. Ask for and accept help, from friends, family and local agencies. Whatever you do, don’t be a martyr.

Keep a sense of humor— we all know that laughter is the best medicine, so go ahead and take a few spoonfuls daily. Relax with a funny movie or TV show. Put on a comedy tape to listen to while you do your chores. Find the humor in everyday things.

Raleigh Geriatric Care Management offers an Adult Children of Aging Parents Support Group.  contact:

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Geriatric Care Managers Explained

Geriatric care managers (GCMs) are usually social workers, psychologists, nurses, gerontologists, or others with both training and experience in a number of aspects of elder care. They can assess needs, handle crises (such as an emergency hospitalization), help place an older adult in a long-term care facility, help solve family disputes, locate community resources, or simply fill in for family caregivers at doctor appointments and assist with other daily care.

For many families, senior care planning and coordination can be overwhelming. In some cases, a loved one’s health needs are at a crisis point and there are too many decisions to make all at once. Or you may live too far from your loved one to check on her regularly. Some aging seniors are resistant to receiving care. In other situations, family conflict can be a major issue.

GCMs are like a quarterback, coordinating all the different moving parts of senior care — from logistics and scheduling to emotional support and family mediation. Their experience can guide you through the challenges you face.


What Geriatric Care Managers Can Do:

Assessment. When you first hire a geriatric care manager, he’ll meet with your loved one (and family members, if appropriate) to evaluate the current situation. He’ll assess your loved one’s physical environment and mental, social, and emotional functioning and independence. Based on this assessment and conversations with family members, the GCM will identify your loved one’s care needs.

Plan of care. Once the assessment is complete, the GCM will make recommendations about the types of care your loved one needs. He’ll meet with you to review these recommendations in detail and get your feedback. He’ll note recommendations in a written plan of care. As care progresses or as care needs change, the care manager will note progress in the plan of care and make updates as needed.

Coordination of services. A geriatric care manager can be as actively involved in the care of your loved one as you need him to be; be sure to clarify expectations at the outset. Most GCMs know all the senior care providers in your area and are well prepared to help you find the best match for your loved one. You can expect him to help you find agencies to provide in-home care, hospice, or skilled nursing care, as well as to coordinate the comings and goings of the caregivers. If your loved one needs residential care, the GCM will help you find the best assisted living or nursing home that meets your loved one’s needs and fits within your budget. Some GCMs will also help with day-to-day care for your loved one — picking up prescriptions, taking your loved one to doctor appointments, or visiting for regular check-ins.

Family support. GCMs also provide invaluable support to family members as they cope with a loved one’s decline or illness. They can help smooth communication and mediate disagreements.

Ideas, products, and innovations. GCMs are always on the lookout for new types of services and tools to make caregiving easier and to help keep your loved one safe. Many will be able to tell you about new technologies, tools, or aids that help your loved one maintain independence and mobility for as long as possible.

In Raleigh , NC, contact: Raleigh Geriatric Care Management.

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Driving Retirement Does Not Have to Equal House Arrest


It goes without saying that for any of us, driving represents freedom, control, and of course, a degree of personal independence. But this is particularly true for the older driver. Here are five reasons a senior driver may not be willing to retire from driving, despite what may be obvious and quantifiable safety reasons:

1) For a senior driver, losing the ability to drive can be an obvious emotional set-back. In some cases, this set-back can be even more complicated when combined with recent losses such as the death of a spouse, a close friend, or a recent diagnosis of a serious health condition.

Imagine for a moment that only months ago your spouse of 50+ years died unexpectedly, and now your adult children are trying to take your car away from you. Or that just last week you were diagnosed with cancer, and today your family doctor compounded your anguish by suggesting that for safety reasons you stop driving, effective immediately. The recipient of all of this wonderful news would certainly feel like a tsunami of doom has just reached their beach.

2)  A senior driver may believe that if he/she can no longer drive, they will become a burden to others. This may be the furthest thing from the truth, but it becomes very real in the eyes of the beholder. Imagine for just one minute that you can suddenly no longer drive…ever. Although completely unwarranted, it is human nature to feel at least somewhat burdensome asking others for help getting you to and from your doctor’s appointments? Taking you to get groceries? Driving you to the hairdresser or barber? Taking you to visit an old friend?

3) Many seniors see a surrender of their driver’s license as an acknowledgement that their physical wellness, agility, mental sharpness, reflexes, sight, hearing or memory are beginning to deteriorate. Or that an illness or pre-existing medical condition is “getting worse”.

4) Many older drivers believe that if they give up their driving, they will have fewer social opportunities than what they are accustomed to.

5) Despite everyone’s best efforts, driving cessation can sometimes trigger depression in elderly people which, in turn can cause a noticeable deterioration in your loved one’s physical health.

There are obviously many, many more examples of the emotional distress driving cessation can cause for an older driver. The good news is; a retirement from a long and successful driving career does not have to be all doom and gloom, and does not have to be the equal of “house arrest”.

Keeping Us Safe provides services to both older drivers and their families across the United States. You can visit them online at or call toll-free at (877) 907-8841 for more information.  In the greater Raleigh area, contact Lauren Watral, MSW from Raleigh Geriatric Care Management at 919-803-8025.

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How to Tell Your Loved One It Is Alzheimer’s Disease

Daniel Paris, MSW

There are a number of takes on telling the person with Alzheimer’s disease (AD) the truth. I would propose a couple of things to keep in mind:

  1. Ask yourself how much your loved one will understand of the explanation. Sometimes they can understand and retain a lot of the information (you have a disease of the brain, etc…); sometimes all they can understand is that they have “some memory loss;” sometimes they are unable to get any of it. Remember, the cognitive impairments of AD affect not only their ability to comprehend information, but also their ability to communicate.
  2. Often someone with Alzheimer’s knows something is wrong, they just can’t figure out what. Are they stupid or going crazy, they may wonder. Finding out there is something wrong that is a legitimate disease beyond their control can actually be comforting at times in this light.
  3. There are some people who will never accept what you tell them due to denial, resistance, the disease, etc. Complicating this can be a host of personality or cultural traits pre-AD. There are times when telling the person can do more harm than good. Because of this, you can’t force them to understand if they are unable or unwilling.
  4. This is an individual decision; you should think about the type of person your loved one is, and how the Alzheimer’s disease has impaired them. You can always try beginning the conversation and see how it goes. If they become very upset and if it doesn’t work, there is a good chance they will not remember the conversation.
  5. Finally, if you are certain your loved one should know, be ready to repeat yourself numerous times as they will probably not remember what you said.

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Caregiver Tips for travel

Traveling long distances with a person in the early stage of dementia may still be quite enjoyable. As dementia advances, however, traveling becomes unpredictable as the person becomes more confusing. Plan ahead for a trip by gathering important documents: insurance cards, passports, your physician’s phone number, refills on medications and a copy of medical records in case the person with dementia needs to see a physician while away. Make sure you keep track of all the documents and medications. Packing them in carry-on bags so they will not get lost en route is a good idea. Remember to bring sufficient funds or a credit card with you in case you must change your plans suddenly and return home. Also, you may want to bring along a brief letter from your physician to the airline or hotel to expedite a change in plans.

When traveling, try to follow the routine that is followed at home. Even minor changes in routine can be distressing to your loved one, and may cause unexpected delays in the delivery of care. So, be sure to allow plenty of time for everything. Plan for rest periods throughout the day. For example, if you are taking a tour by bus, you may want to remain in the bus so the person can take a nap instead of visiting all the sights.

Remember the person who is at risk of wandering when at home, may also do so in an unfamiliar place. If this is the case with your loved one, try using an identity bracelet or necklace that clearly explains that she has a dementia illness. Put a card with the name and address of the hotel where you are staying in the person’s pocket. You may want to carry a recent photo of the person in case she gets lost.

Traveling may also make the person more anxious. Bring along an anti-anxiety medicine just in case. Toileting is an issue that requires some forethought when you are traveling. If you are driving, stop at the rest-area toilets every couple of hours. If the person needs assistance in the bathroom and you may be in there for a while, bring along an “OCCUPIED” sign for the washroom door. Have on hand a full change of clothing. Be sure to keep the way to the toilet well lighted in hotel rooms, and keep a light turned at night in the bathroom.

A few more travel tips to keep in mind: If you are traveling by car, never leave your loved one with dementia alone in the car. Try to bring along a relative or friend to share in the driving. And if you are traveling by plane, you may want to notify the airline ahead of time, so you can ask for any assistance.

Manual of Caregivers by Rush Alzheimer’s Disease Center

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Conversation Topics with Seniors


Ever feel like you don’t know what else to say to a loved one? Longtime companions often feel “talked out.” For others, making conversation with a frail older adult can be hard if you’re unsure what’s safe or comfortable to bring up. Many people balk, for example, at broad questions like, “What’s your favorite memory from childhood?” because they feel put on the spot. And people with dementia may resist direct questioning because they feel like they’re being quizzed and get nervous about being unable to supply a “right” answer. Despite obstacles like these, talk is worthwhile because it passes the time, illuminates things you might not have known about your loved one, and builds new and cherished memories. In a pinch, try this conversation-starter alternative: “Tell me about . . . ” These three little words are nonthreatening and inviting. Casually curious, they work for any topic, from the weather to politics. They allow for open-ended responses. The conversation may go nowhere (try again another time) or take off. Some examples: “Tell me about what winters were like in North Dakota when you were a boy.” “Tell me about your wedding day.” “Tell me about this blanket — you knitted it, didn’t you?” “Tell me about that pet cow you had.” “Tell me about the garden you always had.” “Tell me about why you joined the military.” “Tell me about how you stay so calm all the time.” “Tell me about your mother.” They’re almost as good as those other three little words (“I love you”)!


from Lauren Watral     Raleigh Geriatric Care Management:

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Why Do People With Alzheimer’s Wander?

By  Frena Gray-Davidson

Don’t think Alzheimer’s experts know any more than you about Alzheimer’s behaviors. They don’t. So, your guess is as good as theirs. And, speaking as a longtime Alzheimer’s dementia caregiver, frankly I think caregiver guesses are better than most other people’s. So there! In my workshops, I always encourage family caregivers to guess. If the first guess seems to be wrong, guess again. Always be prepared to try something new when dealing with solving a difficult behavior.

And, by the way, it’s only difficult for you, which is really worth thinking even harder about. Not that you don’t matter because, of course, you do. It’s just that sometimes we’ll label a behavior as difficult and then we’ll fight to stop that behavior. To retrain our person. To make them learn that it’s not what we want.

Boy, now there’s a way to make yourself feel crazy. When we’re specially stressed, we caregivers can get stubborn and locked into our own demands. That’s because of the tightening up we experience as stress. Weary, grieving and overwhelmed, we just don’t tend to say to ourselves, “Now, how can I find a better way to solve this problem?” No, we tend to mutter between our clenched teeth, “If he (or she) doesn’t stop doing that, I’m going to go crazy!” So, figuring out how to find a solution to any dementia behavior problem should be preceded by a warm scented bath, or a session at the gym, a movie you love and then your own self-consulting care plan conference.

So now let’s fast-forward to that relaxed state in which you can ask yourself, ”What exactly is this behavior about and how can I find a solution?” People don’t do things only because they have dementia. Yes, they do have short-term memory issues. And, yes, they are usually unable to do rational step-by-step thinking. Even given those two unfixable issues, people with dementia have a very wide range of possibility in the behaviors they demonstrate.

So, why is your person doing that particular thing? That’s what you have to make guesses about. Your person is targeted on doing what will bring a desired emotional result. That you don’t want them to wander is your problem. Even if you pointed out that certain things are dangerous for them, it means nothing. Why not? Because they don’t remember what the problem was with what they did. And anyway, they feel like that’s what they want to do. And you can’t fight dementia.

So, why does your Alzheimer Dad go wandering? Make some guesses. Ask questions. Ask him, and then ask yourself:

Is he bored? Probably;
Is he restless? Sometimes;
Is he stuck with absolutely nothing to do? Yes, often.
Is he just not used to being this person with dementia? Undoubtedly.
Think about the average person who has dementia. They’ve lost their previous life and have nothing to replace it. Caregivers can be so busy that those they care for are often left in a kind of limbo They can be left doing nothing, having nothing and unable to figure out for themselves what to do.

I always look at the problem things they want to do as their communication to us. So, a walker wants to walk. As my nephew would say, “Duh!” First, everyone else can go walking any time. Except for people with dementia. We even label their walking as wandering. That’s our caregiver jargon which says we don’t want them to do it. It’s dangerous for them and inconvenient for us. If we don’t help find alternatives, however, they will walk out when we’re not looking.


The biggest reason never stated for people with dementia wandering is that this is the way they can self-medicate their anxiety and sense of displacement;
That feeling of displacement drives them to walk out of the front door and straight off down the road, going forward endlessly. It is a feeling that instigates walking and it is dementia which keeps it going. Once people have begun walking, they tend to be unlikely to ask for help or directions and they tend to go straight ahead.
Boredom and restlessness also drive people out of their front doors to find presumably some kind of variety.
This is why the smart caregiver creates an activity plan. For your Dad, maybe he needs a drawer all of his own full of the kind of stuff that used to interest him. Maybe he was a handyman around the home. Then screwdrivers, nails, a hammer – all the equipment of fixing up might keep him happy indefinitely. Maybe a tool box all jumbled up with stuff he can sort out.

How about having him sweeping up the leaves in the backyard? Filling bird-feeders with seed? If you get him weeding, be prepared for the consequences of a person with dementia who no longer knows a weed from a treasured garden guest.

When we craft an activity plan for our family member with dementia we look for something which evokes what was familiar in a way that doesn’t hold to forgotten standards. And as the caregiver, we commit to letting go of our standards of perfection.

The activity works simply by absorbing the person. Sometimes, your Mom could wash and dry the dishes. So what if you have to redo them? Mom felt useful and helpful and it brought back to her a life in which she was the woman who held the family home together.

These activities fill time, yes, but they also remind people who they were when they did not have dementia. I doubt they think it through in that way, though. I suspect they simply feel a more peaceful, more settled sense of belonging.

The desire in the dementia wanderer is often simply to want to go somewhere, anywhere but where they are. In assessing problem dementia behaviors, we always look at both the obvious message and the metaphor. Dementia allows people to operate at a number of different mental levels all combining into this present moment – which in itself might actually be South Dakota, 1926, for the person with dementia. Time zones may blend as that person’s life has now blended into its own story, nearing completion.

How do we bring satisfaction to the wanderer? Well, obviously, an actual walking program is a great idea. The caregiver need not be the one to do this. Ask a family member, a neighbor, a high school kid you trust, a volunteer from the senior center – any of whom can be great company on a walk. Hire someone to do the daily walk – it’ll be a good investment.

To organize this, you plan it, you set the boundaries in time and distance, you train the walker who’ll go with your wanderer. You explain dementia. You prepare them.

Add to this, a driving program. Most people with dementia love a drive in the car. It’s the most active passive entertainment for an elder. It should probably end at an ice-cream parlor or a fruit stand or somewhere else involving food.

The company of others who also have dementia is often very comforting, so look for a good day activity program. How do you know it’s good? See if people are having a good time. Talking like friends. Enjoying the quality of the connection. Dementia is often a lonely condition. The actual activity almost doesn’t matter as long as it clearly connects people by the heart.

The goal of all this is to tire out your family member so that restless dissatisfaction does not speak so loudly to them. Maybe get them a good pet friend, one of those older pets that are so understanding and seldom get adopted..

By the way, don’t forget to secure your doors. You want to know when your person heads for the great outdoors. This doesn’t have to be sophisticated. The things people I know have used successfully have been:

a set of brass bells hanging on a door-handle;
that cheap set of buzzer and five activators that you can put on doors. Not at all expensive — I think around $7 and in most budget stores and hardware places;
a warning door chime;
an ankle bracelet that sets off a perimeter alarm.
Or for the cunning escaper, firmly locked doors, deadbolted and you have the key.
If your person does get out, unnoticed by you, of course you need to go find them. Before you do that, call the police and give a description. Ideally, you would already have lodged a photo with the local police station just in case.

If you have already tagged them with a GPS unit, then your search will be much easier. Check on-line to find great prices on personal GPS systems. It’s something you can tag on the back of someone’s pants each day, for example. Not in pockets or a handbag or wallet – which can be lost or stolen.

If you are looking for someone not tagged, know that people with dementia are most likely to simply continue walking in a forward direction. If you have straight highways from your door, I’d follow those first. If you’re calling out for them, call by name, not by role. So Frank, not Dad. That’s because they may be in a much younger time-zone state of mind where they weren’t a Dad.

I know you will already have got a non-removable ID on your person. Not in a pocket but on a bracelet, anklet or dogtag. You can get these from the Alzheimer’s Association but they’re much cheaper from your local Walmart or equivalent. Put on their name, something like “memory-impaired” and the most relevant phone number.

Have your emergency wanderer kit already – all the numbers, all the friends and neighbors who’ve already agreed to help. Call everyone. Don’t be embarrassed – people love to help in a real emergency.

May all dementia journeys be safe ones.

Raleigh Geriatric Care Management*

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Filed under adult children of aging parents, Adult day care, aging drivers, Aging In Place, Alzheimer's Disease, anxiety and the elderly, assessments, bathing and seniors, care giving, dementia, elder care raleigh nc, Geriatric Care Management, long term care planning, NC, Raleigh, senior care