Thursday, January 22, 2015

Wondering If There's an Alzheimer's Epidemic?

We hear so much about Alzheimer's disease and dementia these days, could it be an epidemic or just information overload? Here's a great graphic with facts you may need to know.

Is There An Alzheimer’s Epidemic? - An Infographic from Bluebird Care
Embedded from Bluebird Care

Friday, January 16, 2015

Is the TV Always Loud Enough to Hear a Block Away?

One of the more difficult issues in caring for aging loved ones is the loss of hearing. Vision usually declines earlier with a need for bifocals in the 40' or 50's, but hearing can be Ok much longer without noticeable decline. At some point you will begin to notice the TV gets louder and louder. You insist you can hear it a block away! You may also notice that your loved one seems to ignore you when you speak. If you point it out, they accuse you of being mistaken or of speaking so that NO ONE can hear you. "You mumble!!"
Stigma of Hearing Loss
Denial is a huge hurdle to face in dealing with the loss of hearing. Being hard of hearing or deaf still carries a huge stigma for much of this aging generation. And if they do admit it, they dig their heals in about any sort of assistive device such as hearing aids. They just want you to speak louder and turn up the TV!

When you can't hear yourself think for all the noise in the house, it's very frustrating and yet probably too late to make much difference.

Get Hearing Tested Early
If you can get them to an audiologist to test the hearing and even give in to buying hearing aids it may be too late for them to actually work very well. But the sales person won't tell you that. In fact they will keep selling them more expensive yet more sensitive models to try to improve what little "hearing" there is. For some people this will work, but for some it's just another frustration and a device that will be found in a drawer and not in the ears.

These sophisticated devices are very sensitive to moisture and any amount of wax in the ears. Tiny holes quickly become clogged and render the devices useless until they are cleaned. And to do so requires tiny, nimble fingers and a few tiny tools. Not something your average aging loved one can do themselves.

To have the best outcomes, the object is to get the hearing tested early on and make decisions before the brain has time to lose much of it's ability to distinguish and understand sounds. As the hearing declines, the brain compensates by trying to distinguish sounds, but actually begins to lose the ability to recognize certain sounds as words. It just becomes a jumbled group of sounds and syllables that make no sense. Amplifying these jumbled sounds with expensive hearing aids doesn't help the brain recognize words it has long sense forgotten the sound of. It's imperative to do something at the first signs if you want to have the best options.

Don't SHOUT!
When someone can't hear us, our first instinct is to SHOUT, but just as turning the TV up louder and louder, it really doesn't help. All we do again is amplify the jumbled sounds. It is far more effective to reduce any extraneous noise and speak slightly louder, facing the person directly. Enunciate clearly and speak SLOWLY; giving the person time to try to read your lips, and time for the brain to compute the sounds into words.

Change the Pitch
With the TV, if you have the capability of adjusting the treble and bass with internal or external speakers, you may be able to significantly lower the decibel level. Again it's not about hearing the sound so much as being able to distinguish the words. This can be especially helpful when your loved one's favorite TV shows include Downton Abbey, Doc Martin and Call the Midwife. The British repertoire on PBS seem to be some of the worst at mumbling in that tone of voice that sadly cannot be easily distinguished. Raising or lowering the pitch may help this process. You can do this with your own voice as well. Either by speaking in a higher pitch, but not quite Minnie Mouse. Or tuck your chin, take a deep breath and speak in a lower tone. Another possibility is to turn on the Closed Captioning to help them find some of the words to follow the plot without blasting the sound.

Acoustics for hearing speech are improved when there are rugs in the room, padded furniture, and no other conversations or background noises to interfere. Try sitting in a high backed booth in a quiet restaurant. Suddenly your loved one thinks the sound has been turned on! But choose a large noisy place and all they can hear is a conversation 2 tables over and nothing from the person shouting directly in to their hearing aid.

Written Communication Works!
When all else fails, be sure to have pads of paper handy, or a white board or chalk board. They can still read. And unless dementia has also set in, they should be able to carry on a conversation and perhaps even begin to recognize the spoken words because they stop trying so hard! Use your smart phone apps if you have none of these handy. Stock the house in as many rooms as possible and see if this can help reduce some of the anxiety!

Growing old sucks, but the alternative????? Adaptation is required!

Here's some interesting facts about hearing aids.

Wednesday, December 31, 2014

Happy New Year 2015

As this year comes to a close, we often reflect back and make resolutions for the new year. Being the caregiver in a sandwich generation will probably be one of the hardest roles you will encounter in a lifetime. Take a deep breath and keep going! Remember to take time for YOU!

Make new memories with loved ones and set in motion plans for your own future to make the burden on your children less as you age. Take time to smell the roses every day and enjoy life. Remember this is not a dress rehearsal; it's the real deal. Enjoy. Happy 2015!

Thursday, September 11, 2014

Never Forget

In September, 2004 we visited NY and I shot this picture. There was nothing quite so sobering as standing at Ground Zero and surveying the damage and feeling the impact this heinous act has imposed on all of us for a lifetime.

Never Forget.

Thursday, July 10, 2014

Need to Have a Realistic Discussion About the Consequences of Falling?

Dealing with an elderly parent or other loved one is a challenge to say the least.  Sometimes it seems like you're dealing with a toddler or small child with an old soul. They want to do things they can no longer safely do and they can get cantankerous and downright obstinate. It's like dealing with a teenager who thinks he is invincible. They want to remain independent and are argumentative about almost everything! It can be most frustrating to deal with.

Safety is one huge issue as balance and gait changes begin to set in with the normal aging process. Chronic diseases such as arthritis, and Parkinson's can complicate the situation because they severely limit joint mobility and cause the gait to shuffle and scissor almost uncontrollably. Dizziness and vertigo play havoc when trying to ambulate and not feel like you're drunk or impaired.

The Fear of Falling
old woman on stairs
Google Images
A fear of falling can cause a person to tense and to make sudden sharp movements as they gain seconds of confidence. Ask your loved one if s/he is afraid of falling and the answer is likely YES! Yet where is that assistive device? The walker is probably back in the bedroom. The cane is next to the door so s/he might remember to take it if s/he ventures outside. And the lifeline device? Oh it's hanging on the lampshade or a doorknob.

Falling is the leading cause of death due to injury among seniors. This is due to complications such as head injury, fractures and immobility related pneumonia. Sometimes if your loved one falls and can't get up it could be considerable time before anyone discovers they are down. This can lead to all sorts of complications such as muscle breakdown that begin in 30-60 minutes, dehydration and hypothermia which can be life threatening or even fatal.

Fifty Percent of Seniors Will Fall Annually
So how do you get this proud, determined, elderly person to actually USE their assistive device and keep that lifeline around their neck?!!  By age 80, 50% of seniors will fall at least once a year. One fall can be too many.  Once a person falls they are more likely to fall again.

Sometimes you have to use the same type of reality scare tactics they used on you when you were that invincible young person. It's also important to remember your job is not to become the parent although it seems like that's what is happening. This makes your job incredibly more difficult and challenging!

These elderly loved ones, no matter how childlike they become, are still our parents, aunts, uncles, grand parents and friends. We need to be respectful while guiding them in the direction of making safe and sane decisions on their own if they are capable of doing so. Alzheimer's and other dementia can take this option off the table quickly.

Discuss Care Options if They Do Fall
But as long as your elder is capable of making decisions, try to have a hypothetical or logical and harshly realistic discussion about what they would want done in case they were injured in a fall. Do they really want to do something to jeopardize their current lifestyle? A typical fall for an elderly person doesn't just result in a skinned knee or bruises. All too often these falls result in broken bones (hips, wrists, shoulders), major skin tears requiring sutures, or head injury.

Would they want surgery to repair a broken hip, wrist, or other joint? Or would they prefer to spend weeks in bed hoping for the fracture to heal so they could eventually be pivoted to a chair or commode for a few hours each day? Would they want to be intubated if they ended up with a very bad case of pneumonia and couldn't breathe?

What if they hit their head and ended up with a brain injury? Would they want to have a feeding tube inserted and possibly need to be sustained on life support devices?

How would they feel about a long rehabilitation process? With a broken wrist for instance they will probably find themselves in need of assistance to dress, bathe, eat and even wipe their own bottom for several weeks! Who would they like to have helping them?

In the course of this conversation, you'll hopefully plant the seed to help them take stock in their own safety and actually use the devices, but you'll also gain some insight into their feelings about general end-of-life desires. It might just open the door to having that conversation soon too.

What Would Help Make the Device More Effective?
Meanwhile, help them to decide which devices they will use. Perhaps a cane needs some sprucing up or decoration to fit their lighthearted personality. Or the walker needs to be outfitted with a basket or tray so they can carry their clothes to the bathroom or bring their coffee cup and cereal bowl to the easy chair.

The device may not feel like it's the right height or doesn't give them the same feeling of stability that hugging the walls or furniture does. Perhaps it's too heavy, or feels flimsy. Maybe they need something different. Sometimes there's a completely logical explanation for leaving the device behind.And sometimes it's just a change they need to vent about and begin to accept.

Be gentle, be kind and be supportive. Change is NEVER easy. And growing old is not fun! But this is for their own good, and your piece of mind. Ahh you are giving them back all the same reasons they gave you growing up for worrying about your safety. Life is a circle and someday you'll be having these conversations with your adult children over your care and safety.  Start making plans to decorate your cane now!

Thursday, January 16, 2014

When the Best Plans Fall Apart....

We plan and we think we are ready for anything and then life happens…. Even with the best laid plans, expect that you are going to be knocked for a loop and totally discombobulated, if only for a little while.

In my observances and my experience, the best possible scenario for caring for aging parents doesn't always just happen. How many times I've heard, "Mom's the one in bad health and she'll die first….." And how many times it just doesn't happen that way.

Dad is a very young 80 and perfectly healthy as well as a good caregiver to Mom, but he needs a little assistance to make things easier. So you hire someone to help with Mom's personal care and a little housekeeping. Things should be OK for a while. Then suddenly Dad has a fatal heart attack and everything is turned upside down.

Mom has lived alone for 20 years and then she had to stop driving. She almost hit someone in her shared driveway and she surrendered the keys. Your friends are envious because it was so easy. You work out ways to assist her and help her stay in her own home. Then suddenly Mom has a small stroke and can no longer live alone. She has no savings. Her income is fixed and low. Her house has a reverse mortgage and the equity was eaten up long ago. Now what?

Suddenly you need to make decisions on a dime that will become permanent and impact your own life more than you ever expected. You thought this was in the bag and you would know what to do when more care was necessary. But life took cruel turns and you aren't prepared for what has to happen.

It will be overwhelming. You will have anger and fear and confusion and be somewhat paralyzed in trying to find solutions. You will want your life back more than you can imagine! And you will find yourself wanting to SCREAM!

My best advice: SCREAM!! Find somewhere where you can do so without scaring a neighbor or summoning the police. A train track can be ideal when the freight train passes by. Or a deserted beach. If all fails, turn on the shower, raise the volume on the TV or stereo, smother yourself into your pillow, and let go!

You will feel better. And you may find that over the course of the next months and years you need to do this regularly. It will help to save your sanity and your marriage. Teach your spouse your tricks and tips.

Prioritize and Delegate
Then you make lists and determine what you can and must do right away and then how you will sort through and find ways to make things work. Enlist your siblings and children to help with necessary tasks. They may not be willing or able to provide any direct care but they CAN help with other tasks so that you can do what has to be done. Don't let them off the hook and stop trying to do it all. It isn't easier to do it yourself now. And your sister won't do things exactly as you would, but she can do it and you can relax a bit. Learn to give up control and delegate.

Learn to Take Care of You
Slowly your wits will come back and your brain will begin to function again. You will find a semblance of routine and settle in to a new life. It won't be the one you had, but it won't be as awful as you recently imagined, at least not every day. You will see new options and make new plans.

Most of all take time for YOU! Don't lose yourself completely. Hang on and climb away from that knot at the end of your rope. Say NO to caregiver fatigue. Reward yourself with a few minutes of "me time" and take advantage every chance you get.

Thursday, December 19, 2013

Happy Holidays!

Wishing each of you a very happy holiday season as we close out the year. May the New year bring you renewed spirit and ways to accomplish new goals.

As caregivers remember to take time for YOU so that you can continue to be the caregiver. Reflect on how you have made a difference and know that things are better because you care. Noting is ever going to be perfect so don't become paralyzed trying to make it be.

Enjoy the beauty of all the decorations around us whether or not they are your culture. Warm glowing lights can help to lift all of our spirits. Take time to enjoy the aromas of the season. Close your eyes, breath them in and take a mini vacation.

Take time to make new memories with family and friends. Capture them on film, and in your mind. 

Set measurable and reasonable goals for the New Year and examine them often to be sure you are on path and reward your accomplishments along the way.