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.

Sixty-and-Me_Urinary-Tract-Infections-Strike-at-Any-Age…-Keep-an-Eye-Out-for-These-6-Signs-740x416

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.

Assistance with Feeding

Assisting someone in feeding is an incredibly important job that should never be taken lightly.  We are not only tasked with ensuring someone receives proper nourishment we are also responsible for promoting their dignity.

  • Create a simple table.  If possible, only the plate of food and drinks should be out on the table.
  • Identify all food items on the plate.
  • Name the food when giving them a bite.
  • Make sure to offer a sip of their juice or water in between foods.
    • So, if you are switching from the green beans to the potatoes take a moment to drink. It clears the pallet and washes any food they may be pocketing in their mouth.
  • Stay in the moment with them.  It is easy to want to watch TV or work on other things while assisting, but as mentioned above eating is social.  Your loved is more likely to engage in mealtime if you are just as engaged.

You Learn Alot About Somebody When You Share a Meal Together

-Anthony Bourdain

 

As a caregiver, there are many things to worry about when it comes to the care and well-being of your loved one living with Dementia or Alzheimer’s.  Eating should not be one of them.  Although there are many reasons why your loved one may not be eating investing time and trying new ways to enhance the mealtime experience for you both is surely worth it.

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.

Relaxation Techniques to Comfort and Calm our Loved ones living with Dementia or Alzheimer’s when they feel Anxious

caregiver-quote_1_square

 

A diagnosis of Dementia or Alzheimer’s can turn our world upside down. Suddenly our once competent and independent loved one is having difficulty recalling some of the most important aspects of their lives.

As caregivers, our relationship with them will undoubtedly change. As we try to navigate our new roles, it is easy to trade away much-needed quality time spent together for doctors’ appointments and necessary errands.  Losing this valued time with our parent or loved one is a more overwhelming and worrying experience than is often acknowledged.

The sudden change in our routines and the new focus on our loved ones’ medical care after diagnosis may seem like the new normal, but it doesn’t have to be.

Proper diagnosis and therapy are important, but humans, and relationships, require much more. A constant focus on this one aspect of our lives is just as stressful for our loved ones as it is for caregivers. No matter what their diagnosis or condition, they still deserve to be treated and valued as a whole person.

Caregiving may now be our primary role, but we are still their child, spouse, or close friend, and we deserve the opportunity to preserve those relationships.

A bit of pampering, and quality time together, can recharge the soul and add a little bounce to all of our steps. So even if we are busy providing care, why not set aside some relaxation time for you and your loved one?

Four Relaxation techniques for Older Adults Living with Dementia or Alzheimer’s

Dim the Lights

Our loved ones living with dementia or Alzheimer’s are extremely sensitive to their environment and can become quite anxious if things are too noisy or if the room is too brightly lit.

Dimming the lights is a simple trick used in virtually every setting and has an amazing ability to calm the atmosphere of a place.  Our bodies will physically respond to dim lights, and almost instinctively we become more relaxed and even a little sleepy.

Relaxation Music

Music is a critical piece to your relaxation day and will set the mood for the occasion. For a relaxation session, try soft classical music, lullabies or non-rhythmic instrumental background music. The soothing sounds will simply make all of those daily worries drift away.

Music is an excellent therapeutic intervention for our loved ones and will almost always calm them if they become anxious or lift their spirits if their feeling blue.  For more tips on how to use music as a form of therapy visit The Alzheimer’s Foundation of America.

Aroma Therapy

Whether you choose to burn candles or purchase an aromatherapy machine, this technique can be extremely useful. Lavender is the most calming of scents and can be used in combination with the relaxation music, creating a truly tranquil space for you and your loved one.

Aromatherapy is also a valuable tool to use to stimulate the appetite. The smell of cinnamon baked apples can be comforting, warm, and homey.  As an appetite boost, try putting it on about a half hour before a meal.  And remember, if it smells like a warm, sweet dessert you should also serve a delicious desert!

** It is important to note: Certain smells may be bothersome, so choosing scents you know your loved one likes will make this activity the most efficient.

Hand Massages

Is your loved one always saying that their hands are cold? As we age, our skin becomes thin, which can cause our loved one’s hands to feel cold and achy all day long. Gentle hand massages can offer temporary relief from such soreness.

First, grab some lotion-try a dab of lotion, some people just don’t like the feel of it! Then start by gently rubbing the inner palm of their hands in a circular motion upwards towards the heart. After, gently move towards the fingers paying close attention to their knuckles. If they can’t verbally tell you that they are enjoying it, a good indicator is if they start to massage your hand back.

For more tips check out Good Relaxation.

 

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.

Taking a Walk Down Memory Lane with a Person Living with Alzheimer’s

Alzheimer’s Patient

First Posted on August 30, 2016, by Sixty and Me

Caring for a loved one with dementia or Alzheimer’s can be an emotional and exhausting process.

A typical day is consumed by activities of daily living, medical care, and the everyday struggles associated with memory loss. When lost in the haze of our daily routine, it can be all too easy to miss out on opportunities to spend quality time with each other.

Whether it’s a parent, spouse, or close friend, our relationship with that person will undoubtedly change. However, this doesn’t mean it stops. Although his or her medical care and needs may become our top priority, we still deserve to have a meaningful relationship with our loved one.

Reminiscing can be a fun and therapeutic experience for both of you. It can create an excellent opportunity to take a break from the demanding daily routine.

Take a walk down memory lane with these fun activities that you can do together!

Trivia and Reminiscing

By starting each day with a morning stretch then a trivia or reminiscing session, we empower our loved ones to keep the body and mind active.

This order is important. We can think of stretching as a warm up session for the mind. Our loved ones will begin to focus on following our movements. This time also gives them an opportunity to become acquainted with the other people or noises in the room.

Once you have stretched, you are ready to begin the trivia fun! For this to work as a reminiscing technique, we should use questions and phrases that will be familiar to them.

For instance, some of my favorites are finishing the sentence.

April Showers bring _______.

It’s raining cats and _______.

A penny for your _______.

Wake up on the wrong side of the _______.

Or famous pairs:

Adam and _______.

Fibber McGee and _______.

Fred Astaire and Ginger _______.

Popeye and _______.

Do these sound familiar? They will for our loved ones, too!

It is amazing how quickly we can recall these fun idioms! Now with everything else going on, it may be difficult to come up with these types of quips on the spot.

You can have a little fun and create a trivia book by searching online and copying them down, or you can purchase trivia books like Finishing Lines or Everyday Life Trivia for less than ten dollars apiece. These and other great activity resources are in the Nasco Catalog.

It is not always easy to have a conversation with our loved ones, but this activity is an excellent way to have an engaging and meaningful back-and-forth with them.

Memory Life-Boards

Our homes are filled with mementos from different parts of our lives. Some of our memories are like old pictures and letters collecting dust in boxes stuffed in the back of our closets. Caregiving often requires us to be always thinking about the next thing on our to-do lists and leaves little time to revisit and reminisce on all of that fun.

A memory life-board is an excellent excuse to get out those old photos and a great way to spend time on rainy days. This project can also be put down and picked back up at any time to suit your busy schedule.

What you will need a poster board, scissors, and glue. You will also require magazines, old photos, and general scrapbook supplies.

First, choose a topic. Is there a particular time your loved one remembers or often mentions? Do they talk about their parents or their childhood home? These may be great points of interest for the board.

Next, try to find images that match this time. Finding the right photos isn’t always so easy to do. Old photos have a habit of getting lost, but other photos in magazines can supplement these images. Reminisce Magazine and Good Old Days Magazine are great resources for these type of pictures.

Once the photos are up, write descriptions of each underneath them. And somewhere on the board write out a brief description of the significance of this time is for your loved one. This is an excellent opportunity to engage them in the activity. Try asking questions like the names of their parents or what color their house was as a child.

You can be as creative as you want with this project. And when it is complete, the board makes for a great talking piece with friends and loved ones who come to visit!

As caregivers, you are often the unsung heroes for our aging population and will spend most of your time focusing on the medical care your loved one receives. But you also deserve to be able to spend time with your loved one and to get to know them during this new phase of their lives.

Are you or someone you know taking care of a loved one who has Dementia or Alzheimer’s? What activities do you do to reminisce with your loved ones? 

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