Helping Children Understand Alzheimer’s

By  Michael Plontz

Your loved one has been diagnosed with Alzheimer’s.  The first thing you want to do is find out all you can about the disease, and all about what you can do to take care of your loved one.  It’s a bitter pill to swallow, but, at least you’re an adult and you can understand what’s happening.  What about your children?  How can you help them cope?

The way in which Alzheimer’s may affect children has to do largely with their relationship with the person before.  If they are close to the loved one, the mentally debilitating illness could cause fear, anger, sadness, and confusion.  If the loved one is living in the home of the caregiver, it can cause these feelings to intensify.

Fear is usually the first emotion to surface.  From the fear of their grandparent or other loved one arises feelings of anger, guilt, and jealousy.  All of these feelings can lead to sadness and even depression.  Also, feelings of despair and helplessness may result from the loss of the loving relationship between child and loved one.

The best thing you can do for your child or teenager is to be completely honest and keep the lines of communication open.  If children don’t understand, they could act out by doing badly in school or withdrawing or becoming impatient with their loved one.  Physical or psychosomatic ailments such as stomachaches or headaches may manifest themselves as well.  They may have to be reminded several times that Alzheimer’s is a disease, and that the disease is what’s affecting grandma or grandpa.

It is helpful to have answers ready for an inquisitive child’s difficult questions.  The following questions are just the tip of the iceberg, but it’s a start.

Q – Is grandma crazy?

A – No. Alzheimer’s is a disease. Older adults are prone to illnesses that may make them forget things or act differently.

Q – Is it my fault?

A – Certainly not.  If grandma told you that, it is just the disease talking.

Q – Can I, or my mom or dad catch Alzheimer’s disease?

A – Alzheimer’s is not contagious, so, no, you can’t catch it like you would a cold.

Q – What will happen next?

A – Here the parent must judge how much information the child can handle.  The best thing to do is reassure them that you love them mo matter what happens.

With teenagers the questions will probably be a bit more complicated.  They can see things from different perspectives.  The best thing to do is to inquire about how they’re feeling, and what can be done to make them feel better.  Regardless of the age of the child, open communication is the key to success in weathering the Alzheimer’s storm.

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What to Do When Parents Must Live Separately: 6 Tips to Help Them Cope

By Dave Singleton, Caring.com author

After decades of living together, one parent needs more care than the other can provide. It’s not only hard on the parents; it’s a devastating situation for children and loved ones, too. You want to help, but you feel helpless in the face of what amounts to a forced separation.

What can you do to ease the trauma and provide support for parents facing this circumstance? Recently, I spoke with two eldercare experts who’ve counseled dozens of families and offer these six practical tips:

  1. Determine in advance how the relationship will continue.

    “Before anyone makes a move, encourage your parents to map out how the marital bond will carry on,” says Mary Koffend, president of Accountable Aging Care Management. Of course, if a parent has dementia or Alzheimer’s, it could be impossible for them to make such a plan. But assuming they can, “if Dad now lives in assisted living, then maybe Mom comes over every day for dinner.” Or perhaps she joins in on a regular activity that they can both enjoy on-site, such as discussions, book clubs, craft sessions, games, gardening, playing cards, or watching television.

  2. Ensure that the facility supports the couple.

    “The key is to promote the couple’s identity as a couple as much as possible, or desirable, for both partners,” says Cheryl Woodson, author of To Survive Caregiving: A Daughter’s Experience, A Doctor’s Advice. “Make sure the facility is convenient for the healthy partner in terms of transportation, access, and schedule.” If transportation to and from the new living facility is an issue, arrange in advance for a loved one or paid caregiver to drive, so that your parents get time together. “Even if it’s brief, at least they talk a bit, kiss good-bye, and off one of them goes,” says Koffend.

  3. Help your parent with feelings of guilt and inadequacy.

    Chances are the parent remaining at home feels tremendous guilt as well as sadness over the separation. “A parent might feel like he’s no longer honoring his wedding vows, or that he isn’t doing enough,” says Koffend. You can be supportive by being the voice that reminds Dad that he’s doing all he can. Give him a dose of what Koffend calls “reality therapy” — in other words, talk him out of wishing for what can no longer be. “Help parents understand the choices they are faced with, and reaffirm that they made the right choices, emotionally and logically,” says Koffend.

  4. Get your parents outside help if needed.

    Sometimes your best efforts might not be enough, and you need to engage outside support. “No matter how cooperative the facility is, no one can understand how bereft these couples may feel,” says Woodson. “Families should encourage the healthy partner to talk to clergy, behavioral health professionals, and/or to participate in support groups with other spouses in similar circumstances.”

  5. Help foster private time, if desired.

    Contrary to popular opinion, the need for intimacy doesn’t end when a separation like this occurs. It might be a little awkward for family members to address (understatement!), but help the couple work through whatever issues might be present in order to get deserved privacy. “For example, if a spouse can’t leave the facility for whatever reason, kids can step in and have a very straightforward conversation with the facility’s administrators about arranging alone-time for the couple,” says Koffend. It’s important to understand the concerns of the facility, which might be liable for falls or health issues that occur under their watch. Koffend cites one example of a wife who brought Viagra to her husband in an assisted living facility, which resulted in him having a strong adverse medical reaction. Address concerns and see if you can set fair boundaries.

  6. Expect the unexpected.

    Finally, “Don’t assume that this transition ends once the initial decision and move are over,” says Koffend. “Be prepared for whatever your parents’ needs are afterward, when there’s sadness or frustration on either side.” For some who’ve spent years caring for a spouse, the transition to living alone can be jarring and rudderless. When primary caretaking is replaced by a facility, you might need to help the parent remaining at home to feel needed and purposeful, whether by encouraging her to see friends or volunteer or simply by facilitating more involvement with her spouse’s new life at the facility. “Help your parent realize they have a practical role in the care and upkeep of their spouse who’s now living in a new place,” says Koffend. “It gives purpose to the visits, even if it’s as simple as bringing a few products and a hairbrush to help maintain physical appearance.”

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Laughter is the Best Medicine

By  Helen Hunter, ACSW, LSW

When was the last time you had a really good laugh?

The scientific definition of laughing is a “successive, rhythmic, spasmodic expiration with open glottis and vibration of the vocal cords, often accompanied by baring of the teeth and facial expression”. That doesn’t begin to tell the story of what laughing does for us, however. The bottom line is that laughing is medically beneficial.

Laughter establishes or restores a positive emotional climate and a sense of connection between two people. In fact, some researchers believe that the major function of laughter is to bring people together – the more social a person is and the more social support a person receives, the more likely that laughter will result from that social connection. Mutual laughter and play are an essential component of strong, healthy relationships. By making a conscious effort to incorporate more humor and play into your daily interactions, you can improve the quality of your relationships.

What are the Physical Effects of Laughing?

Laughing makes people feel good for a reason. Studies have shown that laughter boosts the immune system and triggers the release of pleasure-inducing neurochemicals in the brain. The immune system, which contains special cells that are responsible for defending the body against infection, have been shown to increase during the act of laughing. In the central nervous system, the brain releases powerful endorphins as a result of laughing. Endorphins are natural, morphine-like compounds that raise the pain threshold, produce sedation and induce euphoria (commonly called a “natural high”). In other words, we feel better when we laugh because endorphins reduce physical and mental pain. While this may be a wonderful feeling, laughing has other benefits as well:

During a laugh, respiration, heart rate and blood pressure temporarily rise. This causes oxygen to surge through the bloodstream that then results in lower blood pressure.

Laughter improves the function of blood vessels and increases blood flow, which can help protect against a heart attack and other cardiovascular problems.

Laughter reduces pain and allows toleration of discomfort.

Laughter reduces blood sugar levels, increasing glucose tolerance in diabetics and non-diabetics alike.

Laughter relaxes the whole body, relieving tension and stress. It has been shown that following a good, hearty laugh, muscles in the body are relaxed for up to 45 minutes afterward.

Laughing burns calories – laughter is sometimes referred to as “inner jogging”. A hearty laugh gives the muscles of the face, chest, shoulders, stomach and diaphragm a good workout.

Laughter also helps to create a positive mood. It allows the expression of happiness and the release of anxiety. Humor eases tension and is a great antidote to a stressful situation. Laughter is often seen as a temporary vacation from everyday problems, bringing us to a paradise in which worries do not exist. Humor and laughter are natural safety valves that shut off certain hormones that are released during stressful situations. In fact, your sense of humor is one of the most powerful tools you have to make certain that your daily mood and emotional state support good health.

Here are some ways to bring more humor and laughter into your life:

Smile: Smiling is the beginning of laughter. Like laughter, it’s contagious. When you look at someone or see something even mildly pleasing, practice smiling!

Count your blessings: Literally make a list. The simple act of considering the good things in your life will distance you from negative thoughts that are a barrier to humor and laughter!

When you hear laughter, move toward it: People are very happy to share something funny because it gives them an opportunity to laugh again and feel the humor in it. When individuals hear laughter, they seek it out and ask “What’s funny?”

Spend time with fun, playful people: These are people who laugh easily, both at themselves and at life’s absurdities and who routinely find humor in everyday events. Their playful point of view and laughter are contagious!!

Bring humor into conversations: Ask people: What’s the funniest thing that happened to you today? This week? In your life?

Laugh at yourself: Share your embarrassing moments.

Attempt to laugh at situations rather than bemoan them: Look for the humor in a bad situation, the irony and absurdity of life. This will help improve your mood and the mood of those around you.

Surround yourself with reminders to lighten up: Keep a toy on your desk or in your car. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh. Frame photos of you and your family having fun.

Keep things in perspective: Many things are beyond our control, so make the best of a situation and find the positive in the situation.

Deal with stress: Stress is major impediment to humor and laughter.

Pay attention to children and emulate them: They are the experts on playing, taking life lightly and laughing!!

Here is a simple prescription for a healthy life:

Thirty minutes of exercise at least 3 times a week, and 15 minutes of laughter on a daily basis!!

The bottom line – laughter may just be the best medicine on the market today!

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Who’s Most Likely to Feel Caregiver Stress?

~Paula Spencer Scott

Does caregiving actually cause stress? Some surprising new research says no, the real source of the stress lies within the person, not the situation.

After looking at more than 1,200 female caregiving twins, Peter Vitaliano, professor of psychiatry and psychology at the University of Washington, concluded that how stressful caregiving is for you psychologically is more a matter of your genes and your upbringing. Caregiving itself does not cause stress, he says. This new study appears in the Annals of Behavioral Medicine.

Who’s most at risk, according to this research? People who:

  • Have a history of depression. “Like putting salt in a wound,” says Vitaliano.
  • Grew up with parents who showed a lot of avoidance and fear in response to big stressors (like losing a job).
  • Lack resources to help them cope, like social support and finances.

The study also found that caregiving can cause anxiety, which is in turn linked to depression.

This all may sound like splitting hairs. Though this research confirms Vitaliano’s earlier work debunking a causal connection between caregiving and stress, it flies a bit in the face of many, many other studies that link them. There’s even a name for it: caregiver stress syndrome.

This study didn’t specifically look at Alzheimer’s caregiving, whose duration and unique challenges can wear down even the best-adjusted family member. I wonder, would the results look different?

Bottom line: It doesn’t strike me as terribly helpful to be told your stress is the fault of your genes or your family history. If you’re feeling it, you’re feeling it. It’s nobody’s fault — the real question is what to do about it.

File this info in the nice-to-know category. Then go hide in the bathroom for a little deep breathing, a few bites of dark chocolate, and a wish for some respite time to come your way this week.

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Should You Tell a “Fiblet” to a Parent With Dementia?

From our earliest days we are taught never to lie, especially to our mother or father. However, a recent survey of aging experts reveals that telling a “fiblet” can actually be therapeutic when adult children are faced with telling painful truths to aging parents who have a cognitive impairment such as Alzheimer’s disease.

The National Association of Professional Geriatric Care Managers (NAPGCM) recently surveyed 285 professional geriatric care managers about the most common and difficult situations faced by families who are helping aging parents. Geriatric care managers help these families deal with some of the most sensitive and challenging issues.

More than 90 percent of the professional geriatric care managers surveyed said they have used or recommended the “fiblet” strategy to relieve stress and anxiety and protect the self-esteem of an elderly person. The situation cited most by experts in the survey as an appropriate and helpful use of a “fiblet” is when a senior is refusing clearly needed care or assistance at their home. For example, telling an aging parent with Alzheimer’s that a paid caregiver is coming to their home for their spouse’s benefit or for another concrete role can help the elder maintain pride and reduce anxiety.

The following were identified by care managers as situations when it can actually be therapeutic to tell a “fiblet” to an aging parent:

  • When they are refusing needed care and assistance at home. Telling them the caregiver is there for their spouse’s benefit or for another concrete role can help them maintain pride and reduce anxiety (identified by 83 percent of those surveyed).
  • When they can no longer safely drive, yet insist on doing so. Telling them their car is in the shop getting repaired can reduce confrontations (68 percent).
  • When knowing the cost of in-home care prevents them from accepting the needed service (68 percent).
  • When it would only cause worry and stress to tell them about family problems they can’t solve, e.g., unemployment, financial upheaval, divorce, drug abuse, incarceration (64 percent).

According to the National Institutes of Health, as many as 5 million of the 43 million Americans age 65 and older may have Alzheimer’s disease, and another 1.8 million people have some other form of dementia. Americans feel increasingly challenged by the need to communicate difficult information to aging family members with dementia.

“A therapeutic ‘fiblet’ is just that—it is therapeutic because it calms and reassures, reduces anxiety and protects self-esteem,” said NAPGCM President Emily Saltz. She added, “You would use a ‘fiblet’ only with parents who have a cognitive impairment such as Alzheimer’s disease.”

Geriatric Care Managers Share Their Experiences

As part of the survey, geriatric care managers were asked to provide comments about their own experiences in recommending the use of a “fiblet.” A universal theme of the comments was that family members should navigate this clearly delicate area with help from a support group or from an experienced professional care manager. Care managers also stressed that one should only use a “fiblet” to protect and support a family member rather than for personal benefit or gain.

The following are from among more than 200 stories collected through the survey about geriatric care managers’ experiences of using a “fiblet” in the course of their practices:

  • “I’ve used therapeutic ‘fiblets’ in many instances, but probably (most often) when the death of a loved one is beyond a person’s capacity to understand. For example, if a person is looking for a deceased loved one, I tell them that I haven’t seen that person today but when I do, I’ll tell them that the person is looking for them. This serves to validate their experience and provide reassurance that someone cares.”
  • “When an adult son was diagnosed with cancer, the decision was made to not inform his frail, memory-impaired nursing home-bound father of the diagnosis. At the same time, the son increased his visits to his father during treatment, as he had more free time available for visits. The son and father enjoyed more time together without stressing the father with a scary diagnosis.”
  • “A client wanted to see their mother who had passed away many years ago. Instead of telling her that her mother had died and causing her to grieve again, we told her she was out and would return later. She accepted that and went on with her day.”

Source: The National Association of Professional Geriatric Care Managers (NAPGCM). NAPGCM was formed in 1985 to advance dignified care for older adults and their families. Geriatric care managers are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with caregiving issues. For more information, visit http://www.caremanager.org. –

Raleigh Geriatric Care Management in Raleigh, NC  www.rgcmgmt.com

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Spouses Who are Caregivers

Family caregivers usually are fulfilled by their choice in life to provide much needed care for a loved one who needs that care.

Often we begin caring for our children and then seem to naturally progress to our parents, grandparents or in-laws who may have entered a phase where some level of care from others is required.

It may be something that begins in a small way, such as bringing them food now and then or helping with things around the house. It can quickly progress to more and more tasks and supervision, all the way up to hands on care.

Sometimes, despite all our care and best efforts, it becomes necessary to transition our loved ones in a facility where they can receive more skilled care than we can provide.

Aging in place is a goal for most of us and our senior loved ones and we as caregivers try to do everything we can possibly do to help them make this dream a reality. We will help them create the right living environment with simple modifications and big renovations or even finding a more appropriate home in which to age in place.

Caregivers’ Challenges

Unfortunately, every day is not always the best day. There will be harder days than others, crises that arise along the way including injury and hospitalization. Let’s not forget the occasional (or all too frequent) disagreement about even the littlest thing that soon gets smoothed over when we remember why we are all together.

Caregiver burnout is a reality that we all face. Getting an extra hand, recognizing that we can’t do it all by ourselves day in and day out, can help. Finding respite when you can and an outlet for your feelings will help you be a caregiver longer and better.

I recently came across an interesting poll that found caregiver stress has increased from an interesting source.

Caregivers Who Are Spouses

The Associated Press – NORC Center for Public Affairs Research recently published the results of a recent poll that asked approximately 1400 family caregivers questions resulting in some surprising answers.

They found that most Americans are counting on their families to provide care for them as they age, as they have been doing themselves for other relatives or friends. Unfortunately, not many of us are planning well for our own long term care. We can readily tell you where and how we want our funeral to happen and probably have already made plans and payments for that but we can’t tell you about our goals for day to day care before that happens.

We can’t talk about what kind of a facility we might consider, where we would want to get help, what our care wishes would be, and more importantly have probably not executed any advance directives stipulating our wishes.

This poll found that eight out of ten people found caregiving to be a positive experience but one that is also extremely difficult.

The most stress is being reported by spouses who are now caregivers — not children providing care to parents or grandparents as might be thought. Spouses did promise to care for each other in sickness and in health but find this promise to be stressful to deliver.

Struggling Spouses

Spouses express the struggle that they experience when their relationship changes from companion to caregiver. They deal with not only stress but anger and frustration. It can be hard when hands-on care over grooming, feeding, wound care and other duties are taken on that were once done by nurses now are their responsibility.

While some spousal caregivers report that their marriage is strengthened by their caregiving commitment, which is a welcome outcome in the face of other stressors, spouses were more likely to report that caregiving weakened their relationship with their partner and placed an added burden on their finances.

It is reported that only about 30 percent of those over 40 who may be likely to care for a loved one in the next five years feel prepared to do so. Spouses tend to be older caregivers than those caring for parents and that could make the caregiving more physically challenging as well. The average age of a spousal caregiver is 67, compared to 58 for those caring for parents.

How to Identify and Overcome Caregiver Stress

If you begin to recognize signs that you are having what could be an overwhelming amount of stress that could be harming your health or ability to care for your spouse then it is time to take action.

  • Recognize signs of stress – being tired all the time, having difficulty sleeping, feeling unappreciated with no one to talk to or care about you, feeling depressed or hopeless, not ever feeling like there is a good day, feeling like your own life is not worth living, being ill yourself, crying often or you begin isolating yourself from others.
  • Begin taking time for yourself – sometimes you need to call someone to give you an hour, an afternoon, a day or a weekend off. There are people you can call, such as family members, volunteers from faith based organizations, organizations, home health agencies or friends. Just being alone, taking a breather, shopping, lunch with a friend, sleeping late or seeing a movie can mean a lot to your personal and emotional well-being.
  • Get a medical checkup – schedule a doctor visit for yourself. Get your preventive health checkup or immunizations to help keep you well. You can’t help others if you are not well.
  • Talk to someone – go to a support group locally or online, talk with a member of the clergy, find a friend, or keep a journal so that you can express your feelings and allow yourself to move on past those feelings.

Being a caregiver whether to your spouse, mother, aunt or grandfather not to mention caring for your own children and household will always cause moments of stress. Remember the importance of what you do every day. You are right where you are supposed to be!

Being able to recognize, though, that burnout might be lurking but you can overcome it in order to be the best caregiver possible is the first step in staying well. One smile is all the thanks you need to provide the love and care your spouse or family member needs.

Raleigh Geriatric Care Management in Raleigh, NC  www.rgcmgmt.com

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Vision Loss Affects Our Ability to Communicate

By  Danielle Myers-Rickard

Did you know that by age 70, fewer than 30 percent of elderly people have 20/20 vision?

Normal age-related visual impairments such as macular degeneration, cataracts and glaucoma can impact day-to-day functioning. They can affect our ability to drive, read prescription bottles, safely maneuver an uneven sidewalk, or recognize a friend at church.

Visual impairments can also affect our ability to communicate effectively with others. We observe our partners to see if they “get” what we are saying when we talk to them. Consider the visual clues that we look for during a conversation:

  • Facial cues, which indicate mood or emotion
  • Hand gestures, which can indicate size or direction
  • Turn-taking cues, including raised eyebrows
  • Feedback, such as head nodding

These types of non-verbal messages may be lost or misunderstood by people with poor vision. Both people in the conversation are then prone to misinterpretation. Imagine not being able to see someone roll his eyes when making a sarcastic remark. You might think that he is rude and he might think that you don’t have a sense of humor!

Here are some simple things you can do when talking to someone who has visual impairments:

  1. Identify yourself when going to visit. “Hi Grandma. It’s me, Mary.”
  2. Describe what you mean with words in addition to hand gestures. “The fish was two feet long.”
  3. Sit in a well-lit area, but avoid sitting directly in front of bright windows or standing in doorways. This “backlighting” causes a silhouette effect and people cannot see your face clearly.
  4. Eliminate distracting background noise. When someone has poor vision, he may rely more on his sense of hearing to make up for the loss.
  5. Use bright table or floor lamps whenever possible and ensure cords are out of the way to avoid falls. Overhead fluorescent lighting causes glare on linoleum and hardwood floors.
  6. Install nightlights in hallways, the bedroom and bathrooms.
  7. Offer your arm for support when you are out together and tell him or her about upcoming curbs or stairs.

These tips can help keep your loved ones involved in meaningful conversations and ensure their safety at home.

Raleigh Geriatric Care Management: http://www.rgcmgmt.com

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