Tag Archives: home care assistance

Coping with Depression: Signs You Might be in Trouble

When caregivers take on the responsibility of caring for a loved one, we expect our lives to change. What is unexpected, and often goes unnoticed, is the forfeiting of our own well-being in order to become a primary caregiver.

Ask yourself the following questions. If you answer, “Yes,” to any of them, you need assistance. Support groups, your loved one’s social worker, your physician, counseling or therapeutic centers and a number of other community resources can help you in providing greater balance between your caregiving responsibilities and your well-being.

  • Have you stopped communicating with friends you had before you became a caregiver?

  • Do you lack time to participate in activities that make you feel good?

  • Is your caregiving role negatively affecting your personal relationships?

  • Have you failed to have a check-up lately or find you do not follow the doctor’s recommendation for you own health?

  • Does your loved one need, but not have, a monitoring device?

  • Has your loved one become abusive towards you?

  • Have you noticed you are becoming verbally, physically or emotionally abusive to your loved one?

  • Are you drinking or taking drugs to cope with stress or distress?

  • Has your sleeping pattern changed since becoming a caregiver?

  • Do you feel you are not getting enough sleep?

  • Do you refuse to let others assist you, or give your respite, for fear something will happen if you leave you loved one in another’s care?

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Depression in the Elderly

By Estee Bienstock, R.N.

Depression affects more than 20 percent of our elderly population, aged 65 and older (U.S. Department of Health and Human Services, 2009). For many, depression presents initially late in life. Depression in older persons is closely associated with illness or injury and can cause great suffering for the individual and the family.

Feeling down from time to time, due to life struggles, is normal. Depression, on the other hand, is a REAL medical condition in which a person has feelings of sadness, loss of motivation, and lack of self-confidence. The feelings of hopelessness and helplessness prevent one from enjoying everyday life and affects overall daily functioning. There is a loss of interest, even in one’s family, friends, work or social activities. Depression is often described as “living in a black hole.” Getting through the day can be overwhelming.

There are many reasons why our treasured elderly family members experience depression. These include:

  • Loss of a close family member (spouse) or friend
  • Chronic pain or illness
  • Difficulty with mobilization
  • Frustration with memory loss
  • Difficulty adapting to life changes (i.e., moving residence)
  • Reaction to an illness
  • Side effects of medication

Depression varies from person to person and the symptoms are varied. Women have a greater risk of depression than men. Women tend to have feelings of guilt. Deprivation of sleep is frequently a problem. Women tend to either lose weight or gain weight. When men suffer from depression, they often see it as a sign of weakness. They tend to be more aggressive, angry, violent and reckless. Men have a higher suicide rate. (U.S. Department of Health and Human Services, 2009)

Other symptoms people may have when suffering from depression include:

  • Loss of interest in activities of daily living such as social interactions, work, family gatherings
  • Pessimism
  • Disturbed sleep patterns
  • Irritability, agitation, and restlessness; loss of energy, feelings of fatigue
  • Self loathing, feelings of worthlessness; frequent crying
  • Decreased concentration, difficulty focusing, unable to make decisions,
    memory loss
  • Headaches, gastrointestinal disturbances, muscle aches, and weakness
  • Abnormal thoughts about death

Depression can be difficult to identify in the elderly and is often untreated because many people think that depression symptoms are a normal part of aging or a natural reaction to chronic illness, loss, or dramatic changes in social transition. Contrary to popular belief, depression is not part of the normal aging process. Many elderly people and their families do not recognize the symptoms of depression, are not aware that it is a medical illness, and are not familiar with treatments. It is natural to feel grief in the face of major life changes, such as leaving a home of many years or losing a loved one. Sadness and anguish, natural responses to major life changes, are normal, temporary reactions to the inevitable losses and hardships of life. However, depression is a medical disorder that continues for prolonged periods. Depression requires professional treatment to reduce the intensity and duration of the condition.

Deteriorating health, a sense of isolation and hopelessness, and difficulty adjusting to new life circumstances often combine to create untenable living situations for the elderly. Suicide in our elderly population far exceeds the general population as a whole.

Fortunately, the treatment prognosis for depression is good. Once diagnosed, 80 percent of clinically depressed individuals can be effectively treated. Medication is effective for a majority of people with depression and the elderly respond the same way. (Adams et al, 2007) Medications can be combined with supportive psychotherapy or cognitive behavioral therapy to improve effectiveness. Psychosocial treatment plays an essential role in the care of older patients who lack social support or lack coping skills to deal with their life situations.

Suggestions for activities for skill building with the elderly patient with depression include:

  • Utilize music as a distraction from worries and an assist for relaxation; try it as a sleep aid before bedtime
  • Organize interactions with pets as a relief from loneliness; ask friends or neighbors to visit with their pets regularly
  • As a focus for new growth, assist the patient with nurturing a seedling
  • Select readings as a stimulant for conversations about feelings
  • Encourage reminiscence and sharing of recollections for posterity to increase feelings of self-worth

Caregiver skills that are important to nurturing our elderly patients with depression include:

  • LISTEN
  • Be patient
  • Acknowledge the sadness
  • Resist giving advice, but hone your listening skills
  • Do not pass judgment
  • Promote realistic expectations

Deteriorating health and advancing age present problems for the patient and their loved ones. Issues associated with depression can lead to family conflicts, even more isolation, financial strain, abuse of drugs or alcohol, and thoughts of suicide. Depression, left untreated, prevents elderly loved ones from enjoying life as they have in the past.

A strong support system is often helpful to both the caregiver and the senior person’s well being. Find sources of help for caregiver tasks. Contact family, friends, neighbors, church/synagogue, workplace, Area Agency on Aging or other organizations. Keep looking!

Family physicians can have a significant impact on the health and well-being of the elderly and their caregivers. Family physicians can educate caregivers on behavioral management techniques and coping strategies. By providing the holistic approach to care for patients and caregivers, family physicians can help prepare families for the many phases of this challenging role and allow the patients to feel safe with their dignity left intact.

Raleigh Geriatric Care Management, www.rgcmgmt.com

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Is it Elder Abuse?

By Hilary Wright

Abuse isn’t happening just to toddlers and young children, but is becoming more common among the senior citizens in this country. Unable to take care of themselves, they must rely on a professional or family caregiver to help them from day to day. If you have a loved one who must depend on care from someone other than yourself, you may want to know the tell-tale signs of the many forms of abuse that they may be afflicted with. 

Sometimes, an elder may report an incident of physical abuse; however, they often won’t, so you’ll need to look for other behavioral and emotional signs, like depression or withdrawal from family and friends, changes in behavior, i.e., mood swings or appearing frightened and teary eyed. Sometimes, the abusers themselves will give clues to possible abuse by their refusal to take the elder to the doctor when needed, by not allowing family and friends to see the abused person alone, by giving explanations which are found to be inconsistent with the abuse symptoms.  They may have bite marks and scratches themselves, from an elder fighting back.

Signs of physical abuse:

  • Cuts, lacerations, welt marks (a possible sign of using restraints)

  • Burn marks from cigarettes

  • Malnutrition or dehydration

  • Hair loss from someone grabbing/pulling hair

  • Sores on the body, open wounds

  • Weight gain or weight loss

  • Poor skin conditions

  • Unexplained injuries, such as fractures and breaks

  • Bruises, scratches, bite marks, finger prints

  • Frequent trips to the emergency room

  • Black eyes, broken fingernails

  • Over or under medicated

As much as people don’t want to think about it, sexual abuse does occur among the elderly. It’s considered sexual abuse when something happens either without their consent or when an elderly person is incapable of making such a decision on their own. Physical signs of sexual abuse may include:

  • Bruises around the breast or genital area

  • Cuts or lacerations around the breast or genital area

  • Clothes with blood stains or tear marks

  • Soreness around breast, genital, or anal areas

  • Difficulty with walking or sitting

Some older people may report sexual assault, while others may withdraw from family and friends, flinch at certain quick movements, or be frightened by the opposite gender. The abuser will usually have a story that will not match the physical or emotional evidence noted by family members, and they will generally not allow family or friends into the home or to be around the abused person alone.

Not all abuse can be seen with the naked eye. There’s also emotional and psychological abuse that occurs when a person is demeaning and dehumanizing to another person. Psychological and emotional abuse can also make someone withdraw into depression or even deny that anything bad is actually taking place. You may catch the abuser talking down to the person, calling them hurtful names, and begin to withdraw the elder from visiting with family and friends.

Behavioral signs of psychological abuse:

  • Continuously emotionally upset or disturbed

  • Nervous behavior and a repetition to their actions

  • Negative attitude

  • Agitation or anger

  • Rocking back and forth, sucking their thumb, or even biting (themselves or others)

Financial abuse occurs when a caregiver takes advantage of an elderly person financially, either through stealing money, lying about how much the elder needs for certain care, or cashing the elder’s checks without permission.

Signs of financial abuse:

  • Caregiver withholds money from the elder

  • Checks are cashed without permission of the elder

  • Personal belongings begin to disappear

  • Power of Attorney begins to be misused

  • Caregiver isn’t actually providing the services that are needed

  • Elders aren’t taken to the doctor when needed

  • You notice unusual items being charged on a credit card

  • You notice the elderly person requesting a transfer of assets or funds

  • There’s sudden and abrupt changes in a will

  • They are not aware of where all their money has gone

  • Suddenly, they are unable to pay their bills

  • They are unable to buy clothes, food, and other necessities

  • You notice withdrawals of a lot of money at the same time or within the same week

Another form of abuse is neglect and abandonment, occurring when an elderly person isn’t being cared for properly, like not being fed, bathed, or properly medicated.  Ignoring an elder is also considered a form of neglect and abandonment, because the caregiver refuses to give them any sort of care. The signs of neglect and abandonment can sometimes be noticed with a simple inspection of a loved one, where you may see things like untreated sores or bed sores, malnutrition and/or dehydration, unsanitary living conditions, or dirty bed linens and clothes. You may also notice a strong odor coming from a loved one, due to the lack of continual hygiene, or obvious weight loss or weight gain. Sometimes an elder will actually begin begging you for food, or tell you they have some medical or dental need that hasn’t been tended to.

Although it’s no excuse, caregiver abuse, either by a family member or by a professional, often occurs due to caregiver burnout, caregiver stress, substance abuse, emotional and mental issues of their own, economic conditions or living arrangements. This doesn’t mean that all caregivers are abusers, because very few are; but it’s better to be informed and educated for the safety of your loved one. If it’s a family member who is a caregiver for someone disabled or elderly, you can take some preventative measures in order to prevent it from occurring, or to at least notice it at the very earliest stages. Educate yourself on the signs and symptoms of caregiver stress; make sure the caregiver is receiving help from others, so they don’t have to do everything on their own, which can quickly lead to caregiver burnout; and investigate other living arrangements, in order to take an elderly loved one out of a toxic, ultimately unsafe environment. Elderly people don’t have to be a target for others, especially by those who are supposed to care for them. Older people can also take some important steps on their own in order to make sure they remain safe from abuse of all kinds:

  • Don’t live with a family member who is or has been abusive in the past.

  • Speak to friends often, especially when you feel as though you are being taken advantage of.

  • Review your will. If changes are made, be sure it is because you want them to take place, not because of pressure from family members.

  • Have friends and/or neighbors visit you often.

  • Seek legal advice when making decisions.

  • Have your Social Security or pension check deposited directly into your account.

  • Speak directly to your attorney first before signing a Power of Attorney.

  • Don’t sign anything until you’ve read it. If you have difficulty understanding the legal terms, make sure to seek out an attorney and have them explain it to you.

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Older Adults and Alcohol

A national 2008 survey found that about 40 percent of adults ages 65 and older drink alcohol. Older adults can experience a variety of problems from drinking alcohol, especially those who:

• Take certain medications
• Have health problems
• Drink heavily

There are special considerations facing older adults who drink, including:

Increased Sensitivity to Alcohol
Aging can lower the body’s tolerance for alcohol. Older adults generally experience the effects of alcohol more quickly than when they were younger. This puts older adults at higher risks for falls, car crashes, and other unintentional injuries that may result from drinking.

Increased Health Problems
Certain health problems are common in older adults. Heavy drinking can make these problems worse, including:

• Diabetes
• High blood pressure
• Congestive heart failure
• Liver problems
• Osteoporosis
• Memory problems
• Mood disorders

Bad Interactions with Medications
Many prescription and over-the-counter medications, as well as herbal remedies can be dangerous or even deadly when mixed with alcohol. Medications that can interact badly with alcohol include:

• Aspirin
• Acetaminophen
• Cold and allergy medicine
• Cough syrup
• Sleeping pills
• Pain medication
• Anxiety or depression medicine

Drinking Guidelines for Older Adults
Adults over age 65 who are healthy and do not take medications should not have more than:

• 3 drinks on a given day
• 7 drinks in a week

Drinking more than these amounts puts people at risk of serious alcohol problems.

If you have a health problem or take certain medications, you may need to drink less or not at all.

Source: NIH National Institute on Alcohol Abuse and Alcoholism

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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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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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