Dementia Care: the Benefits of Staying In Their Reality​

timeIndividuals living with dementia or Alzheimers will often speak of their younger years as if it was their current reality.  They tell stories of their childhood home, their parents, and will even feel the need to go home and make dinner for their young children.

Sometimes the need for this reality is so great that they become anxious and even angry when they can’t find what in their mind should be there.

How trapped and powerless they must feel in these moments!  Imagine if we woke up one day and everyone we know and loved were no longer there or if our once routine and purposeful lives were now only a distant memory.

If you’ve cared for someone with dementia you’ve most likely had to “fib” at one time or another. When asked where their mother or father was, you may have said they were at the store; When asked to go home, you may have said it’s too cold to go outside; Or when asked when their kids will be here, you may have replied they are at school today.

These types of answers may not always work as well as we hope they do, but more often than not these responses offer them comfort and a peace of mind in knowing that their mother is still alive and will soon return.

I’ve had many people ask about the ethical implications of lying to someone with dementia or Alzheimers.  However, there are multiple benefits from the practice of being in their reality for both them and us. Because when we engage them in their stories of the past, we learn and connect on their terms, not ours.

Reality Orientation

First, I want to mention the practice of Reality orientation, which is the method of reminding the person with dementia or Alzheimer’s the facts of their current situation. If they wonder where their parents are we tell them that their parents are no longer living or that they can’t go home because they no longer live in their childhood home. We will also remind them of the actual date and time and their current living situation. 

In my experience, reality orientation causes anxiety and can even scare the person with dementia or Alzheimers.  Arguing with someone who has dementia is futile and will often exasperate the situation.  Whether we think they are making up these stories or not when we attempt to correct them we are essentially calling them a liar and taking away any sense of control they may have in telling these stories. 

The Alzheimers Association also stresses the importance of communication with those living with dementia and Alzheimer’s and notes that communication requires patience, understanding, and good listening skills.

Read more: http://www.alz.org/care/dementia-communication-tips.asp#ixzz4r9g3YquZ

Nostalgia

Therapeutic Lying

There are several names we can give to the practice of staying in someone else’s reality:  therapeutic Lying, embracing the reality, or empathy.  No matter what you feel comfortable calling it, the practice itself has multiple uses and benefits for those living with dementia or Alzheimer’s.

Therapeutic lying reduces stress and pain of loss for both the caregiver and the person receiving care.  The Family Caregiver Alliance notes:

People with Dementia Do Not Need to Be Grounded in Reality.
“When someone has memory loss, he often forgets important things, e.g., that his mother is deceased. When we remind him of this loss, we remind him about the pain of that loss also. When someone wants to go home, reassuring him that he is at home often leads to an argument. Redirecting and asking someone to tell you about the person he has asked about or about his home is a better way to calm a person with dementia.”

No matter what strategy or answer we find works best for our loved one staying within their reality rather than bringing them into our own will make them feel more safe and secure at this moment. This practice has a beautiful way of redirecting them so they are no longer concerned about the safety and whereabouts of their loved ones and they can then, in turn, enjoy the moment with you.

Urinary Tract Infections Strike at Any Age… Keep an Eye Out for These 6 Signs.

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First posted on Sixty and Me on May 9, 2017.

Urinary Tract Infections (UTIs) are not an ideal topic for conversation. They are a painful nuisance that accounts for 8.1 million people visiting their primary care physician each year.

However, the severity of symptoms that can occur in an older adult makes it a necessary conversation topic.

UTIs can occur for anyone at any age but are most common in women and older adults. As we get older, however, the symptoms of a UTI will change. If you’ve had one in your life, you know that they can be both painful and uncomfortable. However, aside from the general irritation, and although rare, you may outwardly show changes in your cognition.

UTIs Often Mistaken for Early Stages of Dementia or Alzheimer’s

UTIs in the elderly are often mistaken for the early stages of dementia or Alzheimer’s, according to National Institutes of Health (NIH), because symptoms include confusion or delirium-like state, agitation, and hallucinations. Some may exhibit other behavioral changes, poor motor skills or dizziness, or even fall.

These symptoms may manifest themselves in different ways that often risk the dignity of the infected older adult. It is not uncommon for seniors to do out of the ordinary things such as curse at or threaten to harm their caregivers as well as remove articles of clothing in public.

Unfortunately, when an older adult starts “acting out” or demonstrating “aggressive behavior” the first diagnosis given by health care professionals is a complication due to dementia or Alzheimer’s rather than looking at the behavior as a symptom of an UTI.

These types of drastic personality changes are common, but because the symptoms are so closely associated with dementia, it is often interpreted as just another reminder of our loved one’s cognitive decline.

How to Reduce the Risk of a UTI

UTIs are caused by bacteria in the bladder. People with incontinence or who have difficulty getting up and going to the bathroom on their own are more at risk for UTIs because of the close contact the adult briefs have with their skin.

Here are some suggestions for reducing the risk of UTI. First, drink plenty of fluids (2 to 4 quarts each day) and drink cranberry juice or use cranberry tablets. However, avoid caffeine and alcohol because these irritate the bladder. It may be helpful to set a timer to remind on the use of the bathroom.

For women, do not use douches or other feminine hygiene products and always wipe from front to back. Also, wear cotton-cloth underwear, and change briefs frequently, at least once a day. You can read more suggestions here.

3 Ways to Track and Prevent UTIs

Talk to a Doctor

Left untreated, UTIs can severely compromise the immune systems of older adults. A UTI can be determined with a simple urine test, so asking a doctor to perform a urine test when we notice a sudden change in behavior is a great way to prevent prolonged discomfort and worsening of symptoms for our loved ones.

Take Notes

Family caregivers should always keep notes of their loved one’s medical conditions and behavior even when a UTI is not suspected. Charting this day to day is helpful in managing care, and also allows us to document trends we may not pay too much attention to in the moment. Click here for documentation resources.

Stay Hydrated

Dehydration in older adults is common and is a leading cause of developing an UTI. Drinks like Gatorade and apple juice are popular options to keeping our loved ones hydrated.

Like mentioned above, drinking cranberry juice is a popular home remedy for treating UTIs. This sweet juice is also a more enticing drink to offer our loved ones who just don’t seem to drink enough water. Read more on how cranberry juice fights urinary tract infections here.

Caregiving that Enhances Dignity

UTIs in older adults will cause our parent or loved one to act in all types of ways that may compromise their dignity. As a family caregiver, it is shocking and even hurtful when our loved one becomes angry and threatens us. But taking these types of reactions personally can be detrimental to the quality of care we provide as we may become more cautious or saddened by their new behavior.

As we stop and consider these behaviors as symptoms rather than natural progressions to a disease process we may begin to reframe the way we provide care. Catching these types of changes at the onset of an infection will better allow us to get them the medical treatment they need, but also stops the worsening of these often-uncharacteristic behaviors.

Enjoyable Eats: 10 Tips to Make Mealtime More Enticing for Someone Living with Dementia

Eating
Image Source: Pexels Images

Weight loss is a common and harmful symptom for those living with Dementia and Alzheimer’s. Unfortunately, meal times for our loved one can be stressful, uncomfortable, and even embarrassing.  Coupled with a loss of appetite, ensuring our loved ones eat enough calories in a day becomes a top priority to maintaining their physical well-being.

Make meals more enticing and enjoyable for someone living with Dementia by doing these 10 things:

Eat sweets!

The “no dessert before dinner” rule does not apply here.  Sometimes dessert is the only thing your loved one will be willing to eat, so a double scoop of ice cream is sometimes better than practicing a balanced diet.

You can also, make dishes more enticing by adding a sweet touch.  For example, instead of plain green beans jazz them up with some butter and brown sugar.  Not only are they more likely to eat them, but you’ve almost doubled the calorie intake they would have otherwise eaten.

Make a home cooked meal

Preparing a meal at home is a fun and engaging activity that leaves the entire house smelling delicious.  The smell of dinner cooking is a great way to stimulate your loved one’s appetite and will help orient them to meal time.

Pick out the recipes together

If they are willing and able to help,  go through old family recipes together or scope out new ones online or in a magazine. When we allow them to have a say in the menu plan, there is a greater chance they will enjoy the meal as it promotes their independence and autonomy.

Cook Together

Baking and cooking activities can be a ton of fun, but they also require the use and practice of motor skills. Have them assist in mixing in the ingredients or stirring them all together. These steps require minimal assistance while still essential to the process.

Eat Together

Eating is a social activity, and your loved one is much more likely to eat if someone is sitting there eating and talking with them.  Try discussing some favorite meals you had as a child or other priceless memories that occurred around the dinner table.

You Learn Alot About Somebody When You Share a Meal Together

-Anthony Bourdain

 

A friendly disclaimer: The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. The goal of this site is to promote broad and more positive consumer understanding and knowledge of various aspects of Dementia and Alzheimer’s. It is not intended to be a substitute for professional medical advice, diagnosis or treatment.

How The 5 Senses Can Help Loved Ones Living with Dementia

Senior woman and caregiver at home

Originally posted at Sixty and Me 

Our memories mean so much to us. They provide us with a sense of self and stand as a reminder of the journey we have taken in this life. And the memories we share with the people closest to us become an intricate piece of our identity.

As these memories are so deeply entwined with our sense of self, it is difficult to imagine there could ever come a time that we won’t have them. And understandably, this is a reason why so many of us work to enhance our memory through healthy living choices.

The loss of memory caused by dementia or Alzheimer’s is arguably the most upsetting part of the disease process. And for family and close friends, our loved one’s memory loss may have a profoundly personal effect on our relationships. But it shouldn’t stand in the way of spending time and creating new memories together.

Communication is Key to Helping Someone Who is Living with Dementia

When diagnosed with dementia or Alzheimer’s, it is possible that our loved ones will at times not recognize us for who we are. They may reference us as their mother or father and may not even remember that they are married or if they have children. Although painful, this does not mean that their lives with us have become unimportant, nor does it mean we won’t have more special moments with them now.

How do we respond to our loved ones in these moments? It may feel natural to correct them or to ask “Don’t you remember?” but these types of responses have the potential to embarrass them. Our loved ones do not realize they’ve forgotten something so important, and to be made aware they have can cause a mixture of hurt and confusion.

In their post on memory loss and confusion, The Alzheimer’s Association gives several tips on how to respond and suggests gentle ways we can evoke the memories of our loved ones. Even if they think we are strangers and even if they don’t remember it later, our time spent with them will still mean the world to them at that moment.

Stirring up Memories through our Senses

Sight

Vision 2020’s the Right to Sight Fact Sheet is a wonderful resource when trying to understand vision problems associated with dementia and Alzheimer’s. Sometimes our loved one may not recognize who we are because they are having a difficult time seeing our face. If our loved one begins to lose their vision, finding activities that rely on their other senses is a great way to ignite their memories.

Touch

Tactile stimulation is brain stimulation because it is our brain that feels and recognizes the various textures, temperatures, and shapes. Creating a sensory board of our loved one’s interests or favorite past times is an excellent way to stimulate their memory.

For instance, if your father was a carpenter, incorporating sand paper (which comes in a broad variety of grits), a wood block or maybe even a tool enhances the likelihood he will benefit and interact with the board.

Other suggestions for tactile stimulation include small carpet and fabric samples; pinecones, acorns, and other things found outdoors; peach pits, gourds, avocado, orange, kiwi, and other textured food items; and pieces of ceramic and stone tile (just make sure there are no sharp edges).

Sound

The documentary Alive Inside demonstrates how music can be used as a tool to prompt memory, engage, and create meaningful experiences for people living with Dementia.

Music and memory are a magical duo, and music has a place in almost every situation while working with a person living with dementia. A fun and useful way to enhance the time we spend with our loved one is to listen to music together. Old favorites and popular sing-along songs are a great starting place when using music to reminisce.

Smell

Does the smell of baking remind you of your grandmother’s house? Or the smell of the ocean remind you of past family vacations? These types of memories are an episodic memory and have a powerful way of reminding us of the past.
Enticing their sense of smell is a great way to bring back those happy memories for our loved ones.

Even beyond memory, aromatherapy can also be used to create a tranquil and calming space or as a way to stimulate their appetites. For relaxation, try lavender, sweet orange or jasmine. And for appetite stimulants try baked apples, citrus, and spices.

Living for the Moments, not the Memories

Aging is a natural part of life, and whether we remember them or not, we will continue to have meaningful moments. Our inability to remember does not mean that it has to redefine who we are, nor does it diminish the importance of the many moments that we have collected over the years.

The best gift we can give to our loved one is to create moments that make them feel loved and protected. In a space that is comfortable and familiar, we can decrease their anxiety and make the time spent together meaningful.

Addressing Our Caregiver Shortage through Intergenerational Programs: Introducing our Youth to Seniors Living in Long-Term Care

interages_carousel

As our population continues to age and the demand to age in place continues to grow, family caregivers have assumed the responsibility of caring for our older population. In the post, Investing in the ‘New Normal’: Are Companies Afraid to Admit Caregiving is now a Business Problem? I discussed the need for companies to recognize this growing number of Caregivers since 61% also work a full-time job.

The increase in older adults in need of care also leaves us with another issue: As the amount of non-trained caregivers continues to rise with the increasing number of older adults, the number of professionally trained skilled nursing workers have not.

The sheer quantity of adults 65+ raises concerns since by 2050 the number of older adults is expected to jump to 88 million. At such large numbers, resources are essential to the ability to provide and care for our older populations.

So what happens when our loved ones require more care than we can provide? And a Skilled Nursing or Memory Care facility becomes the only option.  Who will care for our loved ones then?

The most common reason people choose to work in long-term care is that they had a good relationship with an older adult (commonly a grandparent) at some point in their lives.

If we want to successfully foster quality of life for both current and future residents of Long-Term care, we should provide incentives for Long-Term Care jobs through deliberate interventions to introduce younger generations to our aging populations.

Caregiver Shortage

Hebrew Home for the Aged

Reports of caregiver shortages in long-term care settings have increased. AARP estimates that the number of Americans requiring assistance is expected to grow to a whopping 117 Million by the year 2020, where the informal caregiver group will grow to 45 million.

The photo above is a perfect example of what happens when there are more residents than caregivers. Unfortunately, caregiver shortages in LTC have also created a barrier to the successful implementation of culture change. 

Taking care of another human being is not an easy task, and it becomes even more challenging when the person is unable to communicate with their caregiver effectively. Due to a low ratio of staff to the resident, staff is required to be task and time oriented as every resident comes with a checklist of obligations that must be addressed by the end of a shift.

These limitations allow little time for tasks outside of their checklist and discourage meaningful interactions with the residents in their care. It is under these conditions staff burnout is at its highest and staff satisfaction becomes minimized.

Investing in LTC Programs and Education

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Introducing our youth to this incredible generation not only brightens the lives of our elders and youth at the moment. It also plants a seed in our younger generations who will undoubtedly carry the memory of such meaningful interactions as they grow

I had just graduated high school when I was given the opportunity to work in a Continuing Care Retirement Community (CCRC).  While there I formed bonds with residents that I still feel so strongly today. And although I was still just a baby to them, they always treated me with respect and provided me with the encouragement to continue my career in the aging services.

When young students are taught about the aging population, their perspective of age dramatically changes and allows them to develop a sensitivity and understanding of the aging process. We have an opportunity to address our professional caregiver shortage and to create purposeful interventions in the lives of our youth; in hopes one day they too choose a career that benefits our elders.

 

Image Sources
http://www.rosemounttownpages.com/life/4008778-bringing-together-young-and-old
http://www.osuokc.edu/cdls/intergenerational.aspx
https://www.accessjca.org/programs/interages/
https://aging.osu.edu/intergenerational_center
http://www.trendhunter.com/trends/the-learner-link
http://igesl.elevatedpulse.com/programs/intergenerational-service-learning-programs/
http://www.nationalgardenmonth.org/index.php?page=200903storyline
http://newoldage.blogs.nytimes.com/2008/10/02/new-census-data-aging-america/?_r=0

Investing in the ‘New Normal’: Are Companies Afraid to Admit Caregiving is now a Business Problem?

caregiver-stress

Nancy LeaMond (Executive Vice President & Chief Advocacy and Engagement Officer, Communities, States and National Affairs at AARP) reports:

[C]aregiving also has long been, and will continue to be, a business and workforce issue. [S]ix in 10 family caregivers are working while more than one in three are working full time. In fact, the average family caregiver is a 49 year old woman who works 35 hours a week and spends 20 hours a week caring for her mother. At the same time, almost 25 percent of family caregivers are Millennials and the average millennial caregiver is working a full time job. All this boils down to one key point-caregiving and work are the ‘New Normal.’ As workers across all generations are facing the issue of caring for loved ones, employers need to respond.

I’m new to the world of cubicles and water fountain chats, but it has been an enlightening experience, to say the least. I work in public health and every day I share a building with hundreds of different people.

In the short few months I have been here, I’ve noticed an alarming trend in conversations held amongst my co-workers. Where aside from the latest news from ‘Dancing with the Stars’ or the upcoming election, are the in-depth and more personal stories of caregiving.

Just this morning, I walked by a woman noticeably upset at the sudden aphasia (A language disorder that affects a person’s ability to communicate) her father experienced after a recent stroke. She expressed frustration at her inability to understand him, sadness that her father was ill, and exhaustion that now on top of preparing her kids for a new school year she would be spending the next few months searching for care facilities.

And last week, in conversation with a coworker who although has a decent living wage is concerned that her parents, who never saved for retirement, will be retiring just as her second daughter starts college. Responsible for paying for both, she half humorously joked that she has come to realize she will never be able to afford to retire.

In both of these cases and the countless others I have encountered, there was a noticeable trend. As they were speaking, a look of disbelief was in their eyes, a shocked tone in their voice, and a declarative “I don’t know how I’m going to do it” at the end of each story.

‘The New Normal’

The deeply personal stories of caregiving are becoming more frequent in the workplace. And for these workers, strain from outside stressors will undoubtedly have an impact on their productivity and performance. 61% of family caregivers are currently employed either full-time or part-time, and since this number will only increase in the coming years, this issue demands the attention of our businesses.

All across the country, advocates for caregivers  report the push for companies to understand and plan for ‘The New Normal.’ And for good reason, without the flexibility and understanding from businesses, caregivers are faced with the decision to leave the workforce altogether to support the needs of the older adult in their life. Early retirement then puts a strain on their ability to afford their future healthcare needs.

Caregiving as a Business Problem

A work/life balance is an eternal human debate, which stirs up more philosophical discussions too deep to touch on here.  However, we have all felt the pressures at some point to gracefully manage the responsibilities of both.

For family caregivers, the luxury of grace is often too far from reality to even daydream. The average family caregiver of an older adult in America is a 49-year-old female. Too young to retire and still raising a family these individuals/parents/workers/caregivers are left to “figure it out” when it comes to balancing between all of their responsibilities.

Nearly seven in ten (68 percent) caregivers report making work accommodations because of caregiving. -Lynn Feinberg and Rita Choula AARP Public Policy Institute

To not invest in such a vast majority of our workforce population is proving to be bad for business. U.S. companies lose billions of dollars a year due to workers adapting their work schedule to manage their caregiving responsibilities. At such high frequency’s the demands of a caregiver no longer can be just the individual’s problem.

And even more than the companies bottom line is the simple fact that caregiving is stressful! Depression and staff burnout are known side effects of overburdened full-time and part-time worker/caregiver. These conditions severely impact staff morale and the physical health of employees and ultimately the quality of work they conduct in the workplace.

What can employers do?

First, is the acceptance from companies that this is a workplace issue. In recognition, companies will find that there is a range of policies and programs that they can adopt to support their workforce better.

Hold a meeting. You may already have a weekly meeting on the calendar take 5 minutes to announce interest in this initiative and possibly even to survey how many of the employees are in fact, caregivers.

Collect and distribute caregiving resources. AARP is a national leader in advocating for Caregivers. Their program ReAct is an online resource designed for the workplace and offers employers with best practices to support their workforce and maintain productivity.

Start a workgroup. Opportunities for employees to meet with their co-workers and discuss shared experiences can do wonders for the mental health of your employees. Although this meeting could be held before or after business hours holding the meeting during office hours ensures that all employees can attend if they want to.

Consider Telework and compensatory time. The typical 9-5 work day is confining and offers little opportunity to schedule medical appointments for our loved ones where we wouldn’t have to take off work. Teleworking and Comp time provide flexibility to the work week and allow employees to schedule appointments while maintaining productivity.

Investing in our staff creates a more friendly and productive workforce. There are a staggering amount of caregivers with full-time and part-time jobs and the number will only increase over the next few years. Employers have an opportunity to not only foster a healthy work environment within their company but,  also to provide a bit more quality of life for their employees and in turn the older adults that depend on them every day.

Validating our loved ones who no longer connect with words​

Validation

Receiving validation from others, no matter the form, can have a powerful effect on all of us.  Validation lets us know we’ve been heard and that our feelings are important. In both giving and receiving, it can provide our interactions with others with a strong foundation for communication and a better opportunity for a peaceful resolution. Validation transcends the need for spoken communication and targets the human need to have our emotions heard.

Validation is a great communication technique and a key tool to use with our loved ones living with dementia or Alzheimer’s. Their speech may be impaired, but that does not mean they stop communicating with us in other ways.  And when we use validation, we first try our very best to focus on the emotion they are feeling in that moment and not the words they are trying to use.

1. Listen to the tone in their voice.

At first, identifying their exact emotion may be difficult so a good starting point may be too narrow it down to a few emotions. Are they sad, anxious, or afraid? Or are they happy, excited, or playful?

To do this, we may need to ask a few questions or engage in a bit more conversation. You can say, “I can see you are upset, can I help?” this validates that we recognize something is wrong and that we are there for them.

We should then give them an opportunity to express themselves even if the words they use don’t make sense to us. As they finish, we can validate their feelings by saying, “You have every right to be upset.” or “I can see how that can be upsetting.” And if it feels appropriate to redirect the conversation, “How about we go for a walk and get something to drink? I think you deserve to relax for a bit.”

2. Mirror your facial expression to theirs!!

A furrowed brow or a worried looked can say a thousand words.  We may not know what they are worried about, but we can see that they are obviously upset.

In these moments, we should mirror their expression, so if they have a furrowed brow so should we, and if they are smiling, we smile right back! Mirroring their facial expression sends an unspoken validation that you understand how they are feeling.

3. The importance of touch.

A piece of validation therapy is being engaged. If they are pacing back and forth or if they have their hands clenched together there may be something wrong. Try rubbing their back or holding their hand as they are speaking to you or as they pace and always keep eye contact.

It can be extremely frustrating to watch as our loved ones struggle to communicate, but we should always allow them to try. They still have feelings that are worth listening to and this technique allows our loved ones to know that they’ve been heard and understood.

Validation Therapy was founded by Naomi Feil. In the video below, she demonstrates how important validation therapy can be to a person living with dementia.

 

For more on Validation and Redirection read Validation and Redirection Therapy for Dementia from Caring.com