Tag Archives: depression

Nip Depression In The Bud: Warning Signs to Look For

By Mary Damiano

depressionWhile 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.

For a free 15 minute telephone consult addressing caregivers and their aging loved ones, call 919-803-8025.  Visit Raleigh Geriatric Care Management.

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Filed under adult children of aging parents, aging life care association, aging life care professional, Alzheimer's Disease, assessments, care giving, care planning, caregiver burnout, caregiving, Depression and the elderly, Geriatric Care Management

Creating Fun for Caregivers and Frail Seniors

By Lynn Howe

_1571741_origYour confined-to-home (or assisted living or nursing home) parent, just wants to have fun! You are focused on their safety, finances, medical treatment, medications, privacy, nutrition and therapy. You busy yourself with monitoring their progress (or decline) and doing everything in your power to keep them comfortable. You worry about their reduced energy level, increasing fatigue, physical weakness and variable mental status. But do you know how important it is for them to just have fun? To laugh deeply, live in the moment, to briefly not be just old and frail, to forget pain?

OK, so what can you do? I know that you are thinking, well, they can’t do that much, but you might be surprised at all the options. Too often thoughtful families accommodate so much to their senior’s weakening state that they overlook how much they can do and enjoy! While it’s good to try to bring the world to them with visits, letters, phone calls and email, it’s also important and possible to keep bringing them out in the world. Of course, it may involve more work for you — transporting walker or wheelchair, assisting in/out of cars and doors, walking slowly, negotiating steps carefully, finding bathrooms, keeping him/her dry, warm (or cool) — so be prepared for a different pace and smaller goals. And some cajoling might be needed to just get going.

Mini-field trips

Seniors look forward to having a day out, but as they age, they don’t have the stamina or mobility for trips to fascinating museums, over-stimulating casinos, monster malls, giant sports stadiums, wooded parks, loud modern restaurants, etc. But they may be able to go out for an hour or two. My mom adored a simple trip to the supermarket — colorful flowers, fanciful balloons, acres of fresh, bright produce, bakery smells, energetic families with huge carts. She pushed her walker along, senses on overload, straying down enticing aisles. We didn’t buy a thing. But it was an hour that she talked about for days – a new topic of discussion with her nursing home buddies.
Another day we drove one short mile to a local antique shop. “I had those gold Fostoria glasses,” she pointed out. “Your dad and I would stop at the Fostoria factory store on trips to see my brother in Washington, DC.” Talk about the glassware led to reminiscing about her deceased brother, until she0interrupted herself; “Look at the quilts – just like Grandmother’s.” And so on, pushing her walker forward toward the next memory. After about an hour, she had had enough and home we went.

The first trip to a small local department store just before Christmas involved a little arm twisting. But once there, lights, perfume, soft velvety fashions and just ahead a decorated Christmas tree, worked their magic. She wheeled ahead, touching, smelling, exclaiming. Onward through silky lingerie, cute children’s clothes and glittering jewelry. At about the hour mark, like Cinderella, she was done. She relived it all week.

Recently she and I went to a small jewelry store 10 minutes from her home – she had favorite rings that needed resizing. Instead of just taking them for her, I invited her to come along. For the first time in a long time she became the customer, the center of attention. Soon she asked for a chair, her shopping done. But for her it was a big accomplishment, an errand, like in the old days she so misses.

My father-in-law loved an afternoon drive looking at properties we were considering purchasing. He was curious about these houses we described, their yards, their roofs, the neighborhoods. Since we didn’t even bring his wheelchair or get out of the car, it was like a guided tour. “I’ve been in that house” he’d say. “This was always a good neighborhood” he’d remember. “Let’s see what they are building on that hill.” Other mini trips for him were to the cemetery where his wife was buried, their first house in that area and a volunteer organization they founded. He remembered being a neighbor, a businessman, a father and a contributer to the community.
Other ideas might be a quilt shop for a former quilter, a hardware store for the ardent handyman, the library, bakery, family style restaurant, plant store or flower shop.

Fun at home

You don’t have to go out to have fun of course. Opportunities are right there in their home (or facility) to have fun and fight boredom.

  • Stage a sing-along to his/her favorite music. Play the music loud and clear.

  • Get all dressed up and take some photo portraits – use them for family gifts.

  • Rent/borrow movies for slow afternoons – old ones, funny ones, scary ones.

  • Have a deck of cards on hand and play the old familiar games – gin rummy, hearts, war.

  • Scrabble is great fun with grandkids.

  • Keep a puzzle going if you have a spare tabletop – people coming in always get engaged and stay to talk

  • Get out of the room – visit other residents, attend sing-alongs, presentations, craft sessions, chair exercises lunch groups.

  • Pull out a family album – get them to identify the older ones you may have forgotten and take notes or audiotape the stories you hear. Family photos trigger floods of memories.

  • Pick a theme for the week or month. Decorate his/her room and door. It will bring people in to check it out and or conversation.

  • Rearrange furniture and pictures – just for stimulation.

  • Order in or pick up some favorite foods that aren’t on the regular menu – hot dogs for my mom, milkshakes for my husband’s dad.

  • Manicures and pedicures are a special treat too. Have candy for drop-in guests and gifts for visitors – order online; think about birthday and holiday gifts and ‘shop’ on line.

  • Make up a Christmas, holiday or birthday wish list from the web – send it to family members. So think about what your loved one has always enjoyed, listen to what they talk about, look around your neighborhood and give it a try!

Call Raleigh Geriatric Care Management at 919-803-8025 for a FREE 15 minutes phone consultation. lwatral@rgcmgmt.com       www.rgcmgmt.com

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MOST COMMON SYMPTOMS OF ALZHEIMER’S DISEASE

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  1. Memory loss that disrupts daily life
  2. Difficulty completing familiar tasks
  3. Challenges with planning and problem solving
  4. Confusion with time and place
  5. Trouble understanding visual images and spatial relationships
  6. Misplacing things and losing the ability to retrace steps
  7. Decreased or poor judgment
  8. Withdrawal from work or social activities
  9. Changes in mood or personality
  10. Problems with speaking and writing

To learn more about reducing stress as a family caregiver, contact Raleigh Geriatric Care Management, http://www.rgcmgmt.com, or call 919-803-8025.  Call for your free 15 minute consultation. 

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OCD in Elderly for Caregivers

By Cheryl Ellis, Staff Writer @ caregiver.com

Obsessive-compulsive disorder (OCD) is defined in part by the Merck Manual as “anxiety provoking thoughts and urges.” While the publication (a staple in the medical field for years) notes that symptoms are not often prominent in the elderly, caregivers may disagree.

Early stage Alzheimer’s patients may obsess about minor issues, such as the garbage being taken out. In some cases, it may become a “chicken or the egg” question as to which came first, the OCD or Alzheimer’s.
Since part of OCD involves performing repetitive tasks that balance the anxiety (using hand sanitizer repeatedly to avoid germs), it may not be immediately visible that there is an obsessive component to the elder’s thought process. Grandma may spend twenty minutes wiping out the bathroom sink after she has gone to the bathroom. Part of her extended cleaning out of the sink may be due to poor vision, or remembering something from a past not known by current family.

Elder folks who can identify “habits” begin to disassemble the cycle of worry that accompanies OCD. Dorothy, who is well into her seventies and a former nurse, mentions that she has several “habits” that have cropped up since her husband passed away. “I’ll just go right to the refrigerator in the middle of the night, not turning on the light. That’s a HABIT.” She’s noted others, such as waking up several times in the middle of the night. During family visits, she wakes hardly at all, and concludes she’s conditioned herself to associating being alone with needing to wake up.

A bright woman who applied much rational thought and association in her nursing career, she is still able to do so today. Dorothy emphasizes that recognizing a habit is one thing. “Doing something about it, well that’s another!”
It’s evident that the key to her dealing with these habits is making a connection; but more importantly, she has removed the anxiety component. Acceptance of these behaviors and the knowledge that she will break them when she chooses give her a sense of autonomy.

Caregivers can work toward helping their older family members retain a sense of self-control by remaining calm when “habit” strikes. When Grandma spends 20 minutes cleaning the sink, she can be asked “What makes you do such a good job?” This will open the door for her to make her own connection as to why. The caregiver may learn about the past (“My grandfather was in the military and we had to make sure it was clean and sparkling”). Or they may learn about a contemporary occurrence (“I heard my son say the place is a mess. I don’t want him to think I’m a burden”).

In either case, an artful question combined with a compliment may draw out information. It also allows caregivers to begin the process of reassurance which can decrease anxiety.

OCD is designated as an anxiety disorder, and any type of stress reduction technique that is agreeable to the person and caregiver can help tremendously. Aromatherapy, guided meditation, relaxing music and changes in diet (like reducing caffeine) are alternative methods of stress reduction that may have some impact.

Howard Hughes, famous eccentric billionaire, suffered from OCD. Those who have seen the movie “The Aviator” or who remember accounts from decades before have an idea of how bizarre this individual became. While most people live undocumented lives, we can look at the experiences of individuals in public power to relate to.

The Anxiety Disorders Association of America (http://www.adaa.org/) has a great deal of information to educate the layperson on anxiety in OCD, as well as other types of anxiety. Caregivers may find themselves developing a generalized anxiety disorder in response to the OCD disorder for those they are caring for.

Remember that when elders switch locations (moving in with a child, or to assisted living), they are going “out of the box” and stress factors increase. This increase in stress may turn Mom’s “habit” of cleaning when she is a little nervous into a full blown obsession over time. Work on the root cause, always.

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Compulsive hoarding or collecting may have developed from not having enough basic supplies during younger years. The cliché “salad days” may literally have meant that there were only vegetables from the garden to eat. A parent who always made sure there was plenty of food in the house may now not only have 65 cans of green beans (bought at scratch and dent warehouses), but stacks of newspaper coupons that are beyond the expiration date.

Instead of cleaning house in one fell swoop, try getting the elder to focus on the abundant stores they have, and how they can help others who are less fortunate. Some caregivers may have tremendous stress when it comes to dealing with the situation. At that point, calling in the “cavalry” of friends and associates who offer vague help is in order.

“I need you to help by going through Dad’s canned goods to find out which ones are expired or near expiration. Can you go with us to donate them to the local shelter?”

Any problems with compulsive hoarding require help. The Obsessive Compulsive Foundation has a website (http://www.ocfoundation.org/hoarding/) designed to guide caregivers. Support groups and other information can be found there. From that point, work on recruiting friends and family to help you with this issue. In the case of animal hoarding, the local Humane Society may be of help. Never, ever give any pet (hoarded or just a small excess) to anyone you do not know, or to any shelter that you do not know.

Even caregivers can have some obsessive compulsive traits develop with the day-to-day caregiving of an OCD elder. Look through information to see where you may have borderline events, too. By working through your own, smaller issues, you may silently be helping your loved one.

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

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What is an Aging Life Care Professional ™?

We are still the same, but our name has changed to better reflect what we do and who we are. Our national association, formerly known as National Association of Professional Care Managers (NAPGCM), is now  the Aging Life Care Association™ (ALCA) and care managers are now refered to as Aging Life Care Experts™.

Conflicting demands on your heart, time, and energy can make it hard to care for an aging relative. If this sounds familiar, you could benefit from the services of an aging life care expert.

An aging life care expert provides relief. They work with you and your family member to develop a realistic care plan. The goal of the plan is to maximize your loved one’s independence, safety, and quality of life. A solid care plan addresses family resources. This includes making sure you are not called upon to do more than you are able.

An aging life care expert is a guide and an advocate. These experts are typically trained in the health professions or social work. Many have specialties in elder care. They bring to their role an understanding of the

  • local healthcare system;
  • emotional and physical challenges of aging and/or disability;
  • difficulties of adult children juggling work and family;
  • common legal and financial issues that arise in later life;
  • local housing options and other senior or disabled services.

Aging life care experts use a holistic approach. They begin with a thorough assessment of needs and capabilities. They can often resolve uncertainties and dispel family disagreements. Their emotional support may help your loved one come to terms with this new phase of life.

An aging life care expert’s input may save you time and money. After looking at money and other family resources, they can recommend appropriate housing situations. They can identify veteran assistance and other benefits. They can avoid duplication of medical services and potentially catch problems before a crisis blooms. They can also monitor the quality of care.

An aging life care expert works independently as the client’s advocate.They are not paid through referral fees. Nor are they employees of hospitals or insurance companies. In some cases, their services can be reimbursed by long-term care insurance.

If you think you and your loved one could benefit from the services of an aging life care expert, give us a call at Raleigh Geriatric Care Management, 919-803-8025, http://www.rgcmgmt.com

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Caregiver Burnout

By Dr. M. Ross Seligson

Being able to cope with the strains and stresses of being a Caregiver is part of the art of Caregiving In order to remain healthy so that we can continue to be Caregivers, we must be able to see our own limitations and learn to care for ourselves as well as others.

It is important for all of us to make the effort to recognize the signs of burnout, In order to do this we must be honest and willing to hear feedback from those around us. This is especially important for those caring for family or friends. Too often Caregivers who are not closely associated with the healthcare profession get overlooked and lost in the commotion of medical emergencies and procedures. Otherwise close friends begin to grow distant, and eventually the Caregiver is alone without a support structure. We must allow those who do care for us, who are interested enough to say something, to tell us about our behavior, a noticed decrease in energy or mood changes.

Burnout isn’t like a cold. You don’t always notice it when you are in its clutches. Very much like Post Traumatic Stress Syndrome, the symptoms of burnout can begin surfacing months after a traumatic episode. The following are symptoms we might notice in ourselves, or others might say they see in us. Think about what is being said, and consider the possibility of burnout.

  • Feelings of depression.
  • A sense of ongoing and constant fatigue.
  • Decreasing interest in work.
  • Decrease in work production.
  • Withdrawal from social contacts.
  • Increase in use of stimulants and alcohol.
  • Increasing fear of death.
  • Change in eating patterns.
  • Feelings of helplessness.

Strategies to ward off or cope with burnout are important. To counteract burnout, the following specific strategies are recommended

  • Participate in a support network.
  • Consult with professionals to explore burnout issues.
  • Attend a support group to receive feedback and coping strategies.
  • Vary the focus of caregiving responsibilities if possible (rotate responsibilities with family members).
  • Exercise daily and maintain a healthy diet.
  • Establish “quiet time” for meditation.
  • Get a weekly massage
  • Stay involved in hobbies.

By acknowledging the reality that being a Caregiver is filled with stress and anxiety, and understanding the potential for burnout, Caregivers can be forewarned and guard against this debilitating condition. As much as it is said, it can still not be said too often, the best way to be an effective Caregiver is to take care of yourself.

www.rgcmgmt.com  Raleigh Geriatric Care Managment

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For Adults, Coloring Invites Creativity And Brings Comfort

Barbara King

In 1982, anthropologist Adrienne Zihlman, now professor emerita at the University of California, Santa Cruz, published The Human Evolution Coloring Book. Students of biological anthropology were invited to learn about DNA, genes, monkeys and apes — and the fossils, tools and evolutionary relationships of our human ancestors — by coloring in pages rife with factual information presented visually, as well as in words.

A Ph.D. candidate back then, I had never encountered such an object before, with its mix of a children’s activity, as I then thought coloring to be, and an adult student’s science material. I learned from Zihlman’s presentation. Side-by-side skeletal comparisons of the australopithecine “Lucy” and a modern chimpanzee in one case, and robust (large-boned, thick-jawed) and gracile (more slender) australopithecines in another, helped me visualize facts and concepts. I didn’t color in the pictures, though. That seemed, well, just a little bit juvenile to me.

Now, 33 years later, I’ve joined the ranks of adult colorers. We represent a wide range of artistic abilities, including what could, in my case, kindly be called “minimal.” Some of us may prefer the science genre, perhaps marine biology; others steeped in theGame of Thrones novels or show await a coloring book by George R.R. Martin scheduled to be released in the fall. (Given what I hear of the show’s plot, you can bet this coloring book is for adults.)

As for me, I have joined with those delighted by the flowers, birds and beetles inJoanna Basford’s best-selling The Secret Garden, which I first learned about at NPR.

Adult coloring is surging in popularity, and I’ve wondered why. Sure, it is engaging, relaxing and helps combat stress — and who doesn’t in our too-hectic lives need more of that terrific trio? Yet I can experience those things from my primary leisure activity, reading fiction. What coloring offers that reading does not is explained aptly by clinical psychologist Kimberly Wulfert for EverydayHealth.com:

“In coloring, you’ve got this physical sensation of the tool you’re using touching on the paper. You also have the feeling in your hands and fingers holding this tool, and moving in different rhythms as you fill in the space,” she says, adding that “you’re being mindful, and when you move in a rhythmic fashion for an extended period of time, that becomes a meditation.”

For me, after a day of writing and reading nonfiction for work, then reading a novel for pleasure, coloring brings a different kind of sensual engagement, one that perhaps echoes the embodied pleasures found in creative cooking, gardening and carpentry. But even that isn’t the full story.

Basford’s two coloring books (The Enchanted Forest is the other) are so popular that a long wait to obtain one is now commonplace. I waited for two months for The Secret Garden.

While I was waiting, my personal world shifted suddenly. On April 17, my mother died. Just in February, I had written admiringly of her enthusiasm for reading science books even while struggling with vascular dementia. Is it possible to say that an 88-year-old woman with COPD (chronic obstructive pulmonary disease) died unexpectedly? Yes, I think so. On that Friday, I visited with her in the afternoon, saw her fatigue, and tucked her into bed. She expressed no physical complaints, and we parted lovingly at 4 p.m. with every expectation of another visit soon. By 7 p.m., she had died.

I’m grateful that my mother died in her bed, peacefully. And, yet, my grief is still fresh.

Perhaps coloring for me, right now, offers something more than the benefits I’ve already described. Maybe it offers me the very mix I wasn’t able to value in my 20s: the combination of remembering the comforts of being a child while incorporating the creativity of an adult.

Most evenings, I take out my pencils, savor the shades I choose — golden yellow, jade green, peach — and start coloring.

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

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